Abstract Background: Informal caregivers are increasingly important in the care for people with dementia. When people with dementia live in a nursing home this involvement often continues. The...Show moreAbstract Background: Informal caregivers are increasingly important in the care for people with dementia. When people with dementia live in a nursing home this involvement often continues. The Namaste Family Care program focuses on including the informal caregiver in the intervention for people with dementia that no longer benefit from regularly organized activities in the nursing home. The aims of the current study are to identify characteristics of informal caregivers and care recipients that influence the report of positive caregiving experiences, and identify the influence of the Namaste Family Care program on caregiver burden and positive caregiving experiences. Methods: Nursing homes were randomly assigned to the Namaste (n=107) or the control (care as usual; n=105) condition. Within the nursing homes informal caregivers (n=212) and their relative with dementia were recruited. Measures included positive caregiving experiences, caregiver burden, demographic characteristics and severity of dementia. Positive caregiving experiences were measured using the Positive Experience Scale (PES; De Boer et al., 2012) and Gain in Alzheimer care INstrument (GAIN; Yap et al., 2009). Caregiver burden was measured using Zarit’s caregiver burden scale (ZBI, 7-item; Zarit et al., 1980) and severity of dementia using the Bedford Alzheimer Nursing Severity-Scale (BANS-S; Volicer et al., 1994). Demographic characteristics included age, gender, relationship to the care recipient, educational background, employment, and religiousness and were measured using the Informal Caregivers Survey–Minimum Data Set (TOPICS-MDS; Lutomski et al., 2013). Questionnaires were filled in by the informal caregiver and nursing staff at baseline and 3-month follow-up. Results: Women reported higher PES scores than men (p < 0.01) at baseline. Higher educated people reported lower GAIN scores (p < 0.01) at baseline. People that perceived religion as very important reported higher GAIN scores (p <0.01) at baseline. Higher education (p = 0.025), age (p = 0.007) and employment (p = 0.03) were predictive for positive caregiving experiences. Caregiver burden was significantly lower (p = 0.017) at follow-up (Mean = 12.27, SD = 4.88) when compared to baseline measures (M = 12.93, SD= 5.62). No significant differences in positive caregiving experiences were found between conditions (Namaste vs. control). The mediation analysis showed no significant mediating characteristic between caregiver burden and positive caregiving experiences. Conclusions: Older and employed people are more likely to report positive caregiving experiences and higher educated people are more likely to report less positive caregiving experiences. Future research should include more follow-up moments to get a more complete image of the perceived influence of the intervention. The current conclusions can be used to identify caregivers ‘at risk’ for negative experiences and burden in their role as caregiver. It also contributes to the evolvement of interventions for people with severe dementia in nursing homes. Samenvatting Er wordt een steeds groter beroep gedaan op mantelzorgers in de zorg voor mensen met dementie. Ook na opname in het verzorgingshuis blijven mantelzorgers vaak zorgdragen voor de familieleden met dementie. Het Namaste Familie programma is opgezet om activiteiten te organiseren voor mensen met gevorderde dementie die niet langer kunnen participeren in de georganiseerde activiteiten van het verpleeghuis. Het Namaste Familie programma betrekt de mantelzorgers actief in deze activiteiten om bezoeken aan de familieleden met dementie leuker en gemakkelijker te maken. De 212 mantelzorgers en hun familielid met dementie zijn willekeurig toebedeeld aan het Namaste Familie programma (107 participanten) of de gewone zorg (105 participanten). Informatie over positieve zorgervaringen van de mantelzorgers, mantelzorger belasting en demografische kenmerken van de participanten werd verzameld tijdens een baseline meting en na 3 maanden. Dit onderzoek richt zich op het vinden van karakteristieken die positieve zorgervaringen voorspellen. Daarnaast is het doel om de invloed van het Namaste Familie programma te vinden op mantelzorger belasting en positieve zorgervaringen. Uit de resultaten bleek dat vrouwen meer positieve zorgervaringen hadden dan mannen. Mensen die religie belangrijk vinden in hun leven hadden meer positieve zorgervaringen dan minder religieuze mensen. Mensen met een hogere opleiding hadden minder positieve zorgervaringen dan gemiddeld en laagopgeleiden. Kenmerken die positieve zorgervaringen kunnen voorspellen zijn, een hoge leeftijd en werkzaam zijn. Een kenmerk dat positieve zorgervaringen kan belemmeren is hoog opgeleid zijn. Verder hadden mensen minder mantelzorger stress na 3 maanden wanneer vergeleken met de baseline meting, maar het programma had hier geen invloed op. Het programma heeft geen duidelijke invloed gehad op positieve zorgervaringen. Ook zijn er geen karakteristieken gevonden die een effect tussen mantelzorger belasting en positieve zorgervaringen beïnvloeden. Conclusies uit dit onderzoek zijn dat oudere mensen met een baan meer positieve zorgervaringen, en hoger opgeleide mensen minder positieve zorgervaringen rapporteren. Door deze conclusies kunnen mantelzorgers die risico lopen op negatieve ervaringen tijdens hun rol worden gevonden en beter worden geholpen. Daarnaast kunnen zorgprogramma’s en interventies rekening houden met deze bevindingen om de mantelzorger te ontlasten van hun zorgen en of ze hulp te bieden bij moeilijke zorgtaken.Show less
Background and objective: Basic activities of daily living (BADL) are expected to be less susceptible to cognitive impairment or decline than instrumental activities of daily living (IADL). This...Show moreBackground and objective: Basic activities of daily living (BADL) are expected to be less susceptible to cognitive impairment or decline than instrumental activities of daily living (IADL). This study aimed to enhance insight in brain metastases patients’ ability to fulfil BADL and IADL, and to investigate the degree to which cognitive impairments associate with both categories of ADL. Methods: Differences in BADL and IADL functioning between patients with and without cognitive impairments were determined. In addition, correlations between a change in cognitive functioning and a change in IADL functioning over three months were calculated. Results: A total of 75 patients were included in this analysis, 36 of whom completed follow-up assessment on at least one cognitive domain. As expected, no difference in BADL between cognitively impaired and unimpaired patients was found. Unexpectedly, no differences were found for IADL and overall cognitive status either. Over time, however, deterioration in some specific neurocognitive domains was associated with a decrease in certain IADL performance, although correlations were weak to moderate (range: ρ = 0.338 - 0.475). Conclusion: This study did not provide evidence that overall impaired cognition influences IADL functioning but did indicate a positive association between executive functioning and IADL performance. Further research is needed to better quantify the association between cognitive and ADL functioning in brain metastases patients, and to assess whether this finding holds true for patients with other types of brain tumors.Show less
Background This study aimed to identify predictors of quality of life (QoL) in nursing home residents (NHR) with dementia, specifically examining the influence of a body mass index (BMI) between 20...Show moreBackground This study aimed to identify predictors of quality of life (QoL) in nursing home residents (NHR) with dementia, specifically examining the influence of a body mass index (BMI) between 20 and 30, gender, pain severity, and challenging behavior under consideration of the biopsychosocial model. Additionally, it evaluated whether challenging behavior severity mediates the relationship between pain severity and QoL. The study findings can inform targeted interventions aimed at improving QoL in NHR with dementia. Methods Data for this cross-sectional study were derived from the baseline measures of the Dutch Namaste study (NTR5692) resulting in 226 participants (27% male) with a mean age of 86 years (SD=7). Information on QoL, pain severity, and challenging behavior severity was taken from the QUALID, PAINAD, and NPI-Q measures. For the control variable dementia severity, data from the BANS-S measure were derived. Information on gender and BMI were taken from data supplied by the NHR ́s physicians and primary nurses. Three regression analyses were performed to determine whether each higher severity of pain, challenging behavior, and female gender would predict lower QoL. Two multiple regression analyses were performed to determine whether pain was the strongest predictor of QoL and whether a BMI between 20 and 30 would predict higher QoL than values outside the range. To establish whether higher challenging behavior severity was a mediator between pain and QoL, a mediation analysis was performed. Results Higher severity of challenging behavior was a significant predictor of lower QoL in NHR with dementia (R2 = .45, F(2, 212) = 86.04, β = .69, p < .01, 95% CI [-.57, .81]), but it did not mediate the relationship between pain and QoL. Female gender, higher pain severity, and a BMI range of 20 to 30 were not predictors of QoL. Conclusion The findings highlight the importance of intervention programs that target challenging behavior to improve and maintain QoL in NHR with dementia. More research in this area is needed. In addition, it should be established whether different BMI scores can be predictors of QoL.Show less
Research on executive functions in young children is lacking and inconsistent due to inadequate tests for this age group, although important since the development of executive functions is critical...Show moreResearch on executive functions in young children is lacking and inconsistent due to inadequate tests for this age group, although important since the development of executive functions is critical for behavioral, cognitive, and social development throughout life. The aim of this study was to examine the relationship between motor performance and working memory, a core executive function, in typically developing young children. In addition, this study investigated whether age and socio-economic status moderated this relationship. In this cross-sectional study, a test battery developed by Utrecht University was used to measure young children’s working memory (n = 187) during a house visit. Motor performance, including fine and gross motor skills, was measured with ten questions from the Ages and Stages Questionnaire (ASQ), filled out by the parent. Socio-economic status was measured by asking about the highest achieved education. Children were recruited by master students in their own personal network and via several institutions for young children (e.g. day-care, preschool, etc.). Pearson correlation and multiple regression analysis were performed to answer the research questions. Results revealed a significant positive correlation between fine motor skills and working memory in typically developing young children. However, no significant correlations between other aspects of motor performance and working memory were found. In addition, there is no evidence for a moderating effect of either age or socio-economic status in the relationship between any aspect of motor performance and working memory in typically developing young children. These outcomes have an important implication in research, offering more evidence for a correlation between fine motor skills and working memory at a young age. Additionally, these outcomes give an indication of how factors can influence the development of executive functions.Show less
Multiple Sclerosis (MS) is a chronic disease of the central nervous system that affects an estimate of 2.8 million people worldwide. Fatigue, impairments in processing speed, and depression are...Show moreMultiple Sclerosis (MS) is a chronic disease of the central nervous system that affects an estimate of 2.8 million people worldwide. Fatigue, impairments in processing speed, and depression are common symptoms reported by People with MS (PwMS). However, the relationship between these symptoms is not well understood. This study aimed to investigate this relationship and examine the (in)stability of fatigue levels over time in PwMS. The study utilized a longitudinal, retrospective cohort design and included participants diagnosed with MS (n= 141) who attended a specialized clinic in Overpelt, Belgium. Seventy-three percent of the sample was female, with a mean age of 51.88 (SD ±13.46). The average disease duration was of 16.94 years (SD ± 8.86), and a majority of the sample had the relapsing-remitting type of MS (RRMS) (n= 43). The median of disease severity, as measured by the EDSS, was of 3.50 (IQR – 3.5). The study hypothesized that fatigue levels would increase over time and that depression would moderate the relationship between fatigue and processing speed. Fatigue levels did not significantly change over time (p = 0.055). A significant relationship was found between fatigue and processing speed impairment (p < 0.05). However, depression did not significantly moderate this relationship (p = 0.215). These findings show that cognitive symptoms may influence each other in MS. Future research should look into the relationship of mood disorders, such as anxiety and depression, and cognitive impairment in PwMS.Show less
Anorexia nervosa (AN) has the highest mortality rate among all psychiatric disorders, with approximately 5% of the patients dying within four years of diagnosis. Since AN is influenced by various...Show moreAnorexia nervosa (AN) has the highest mortality rate among all psychiatric disorders, with approximately 5% of the patients dying within four years of diagnosis. Since AN is influenced by various factors, predicting the clinical course remains challenging. As previous studies have suggested that early intervention for AN may have the greatest potential to reduce harm, it is important to diagnose AN at a very early stage and provide a tailored treatment plan. This study aimed to examine whether readiness and motivation to change and neurocognitive functioning predict treatment outcome during the acute phase of AN. The objectives of this study were to examine whether readiness and motivation to change predicts (1) changes in BMI-SDS and fat percentage after one year of treatment, (2) changes in severity of anxiety, depression, and Obsessive-Compulsive Disorder (OCD) symptoms after one year of follow-up, and (3) whether neurocognitive functions predict changes in BMI-SDS and fat percentage after one year of treatment. A longitudinal study was conducted in a sample of 79 first-onset AN patients aged from 12-22 years. Readiness and motivation to change was measured using the Dutch version of the Readiness and Motivation to Change Questionnaire. BMI-SDS was measured by calculating BMI-length/weight SDS. Fat percentage was measured using the BOD POD. Anxiety, depression, and OCD symptoms were assessed with the Screen for Child Anxiety Related Emotional Disorders, the Dutch version of the Beck Depression Inventory, and the (Children's) Yale-Brown Obsessive Compulsive Scale, respectively. Neurocognitive functioning was measured with the Wechsler Abbreviated Scale of Intelligence and the Rey Complex Figure Test. Simple linear regressions showed that readiness and motivation to change and neurocognition in the acute phase of the disease did not significantly predict changes in BMI-SDS, fat percentage, or changes in symptoms of anxiety, depression, and OCD after one year of follow-up. Future research should aim to examine readiness and motivation to change for each symptom domain instead of a global state, differentiate between intelligence levels, examine treatment outcomes in a multidimensional view, and assess multiple points in time.Show less
The gut microbiome is comprised of the bacteria, viruses, and fungi that reside in the gastrointestinal system. These have been linked to a weakened immune system, and the increased presence of...Show moreThe gut microbiome is comprised of the bacteria, viruses, and fungi that reside in the gastrointestinal system. These have been linked to a weakened immune system, and the increased presence of negative health conditions like infectious diseases, inflammatory bowel disease and autoimmune diseases. Research is increasingly focusing on the relationship between the gut microbiome and the brain. This has facilitated the development of the gut-brain axis concept, which explores how the gut microbiome can affect the brain. Despite the growing attention to this topic, the relationship between the two remains largely unclear. This study aimed to investigate the link between gut microbiota and overall brain volume as well as the volume of specific brain structures. This study used a sample of 9–11-year-old children derived from the Generation R Study (n = 1,531), which has recently become the largest pediatric study with microbiome and neuroimaging data. This study found that lower gut microbiome diversity did not significantly predict total intracranial volume (β = 0.003, p = .904), white matter volume (β = -0.015, p = .530) and gray matter volume (β = -0.001, p = .970). Similarly, the study did not identify any significant predictions between the gut microbiome and smaller brain structure volumes (i.e., structures of the limbic system and prefrontal cortex). Although a microbiome significant, weak regression coefficient was found with the medial orbitofrontal region (β = -0.041, p = .039), it did not withstand correction for multiple testing. These findings were contrarily to previous animal models as well as small human studies providing evidence for associations between gut microbiome and brain structure. In conclusion, using the largest sample to date, we could not identify strong significant predictions between gut microbiome diversity and brain volume in children. Future research repeated measures will be crucial in determining any links between the gut microbiome and brain development from childhood to adulthood.Show less
This study aimed to create a better understanding of the neurobiological mechanisms underlying the induction of nocebo hyperalgesia. Nocebo hyperalgesia refers to an increased pain perception...Show moreThis study aimed to create a better understanding of the neurobiological mechanisms underlying the induction of nocebo hyperalgesia. Nocebo hyperalgesia refers to an increased pain perception resulting from negative outcome expectations, a phenomenon that can negatively influence a patient’s clinical outcome. Much concerning the mechanisms underlying the induction of nocebo hyperalgesia is still unknown, although it can be hypothesized that NMDA receptor-dependent learning may play a role. The current study tested this hypothesis by pharmacologically manipulating NMDA receptor- dependent learning in healthy participants, expecting that the pharmacological manipulation would facilitate the induction of nocebo hyperalgesia. Participants (n = 50) received either a placebo or an 80 mg dose of D-cycloserine (DCS), a partial NMDA receptor agonist. Nocebo hyperalgesia was induced in both groups with verbal suggestions and a classical conditioning paradigm consisting of an induction and evocation phase. In the induction phase, high intensity heat-pain stimuli were given during trials where a sham electrical stimulation device was supposedly turned on (nocebo trials), while moderate heat-pain stimuli were given during trials where a sham electrical stimulation device was supposedly turned off (control trials). During the evocation phase, only moderate pain stimuli were given. Nocebo hyperalgesia was indicated when participants rated their pain higher during nocebo trials compared to control trials. A significant paired-samples t-test (t (49) = -8.55, p < .001) suggested that nocebo hyperalgesia was successfully induced in both groups, further confirming that nocebo hyperalgesia can be induced by classical conditioning and verbal suggestions. Nevertheless, the pharmacological manipulation of NMDA receptor-dependent learning with 80 mg DCS did not facilitate the magnitude of the induced nocebo hyperalgesia more than a placebo, as indicated by a one-way ANOVA (F (1, 49) = 0.028, p = 0.867). The usability of DCS in nocebo research was discussed, and further research was recommended. It is important that the current study is replicated, possibly with the use of another glutamatergic agent. The results from future studies could play a significant role in diminishing the impact of nocebo hyperalgesia on clinical practice.Show less
Introduction: Dravet Syndrome (DS) is a severe epileptic encephalopathy, generally characterized by refractory seizures, cognitive impairment, and behavior problems. Health-related quality of life ...Show moreIntroduction: Dravet Syndrome (DS) is a severe epileptic encephalopathy, generally characterized by refractory seizures, cognitive impairment, and behavior problems. Health-related quality of life (HRQoL) assesses the impact of a chronic disease on an individual’s well-being. This study investigates the course of HRQoL in patients with DS between 2015 and 2021/2022, and whether the course of HRQoL can be predicted by age, the course of minor and major seizures, cognitive impairment and behavior problems. Additionally, this study aims to explore the relations between parental empowerment, parental distress, and the HRQoL in patients. Methods: This study is partly longitudinal (N=41) and cross-sectional (N=51), and uses data from three different studies. The outcome variable HRQoL was assessed with the Pediatric Quality of Life Inventory (PedsQL). Parental empowerment was measured with the Family Empowerment Scale (FES) and parental distress with the Distress Thermometer for Parents (DT-P). A multiple linear regression analysis was conducted to see which comorbidities significantly contributed to the prediction of the course of HRQoL. Moreover, a mediation analysis was performed to study the relationship between parental empowerment and parental distress, with the hypothesized mediating role of HRQoL in patients. Results: HRQoL scores improved significantly over time (t(40) = -3.40, p = .002, d = 0.53). Only predictive factors age (t(35) = 3.03, p = .005) and the course of behavior problems (t(35) = -2.46, p = .019) contributed significantly to the prediction of the course of HRQoL. Lastly, no relation was found between parental empowerment and parental distress, indicating no mediation. However, significant associations were found between parental empowerment and HRQoL in patients (r(51) = 0.31, p = .029), and parental distress and HRQoL in patients (r(51) = 0.54, p < .001). Conclusions: This study suggests an improvement of HRQoL is predicted by an increase of age and a decline of behavior problems. Therefore, it would be beneficial to involve multidisciplinary teams including psychologists to provide support for behavior problems. Lastly, this study emphasizes the crucial role of the well-being of the caregivers, and advises healthcare professionals to pay attention to the caregiver’s care needs.Show less
Mutations in the SCN1A-gene cause a spectrum of epileptic syndromes, ranging from syndromes with mild febrile seizures and/or epileptic seizures (Genetic Epilepsy with Febrile Seizures plus (GEFS+)...Show moreMutations in the SCN1A-gene cause a spectrum of epileptic syndromes, ranging from syndromes with mild febrile seizures and/or epileptic seizures (Genetic Epilepsy with Febrile Seizures plus (GEFS+) and Febrile Seizures plus (FS(+)) to Dravet Syndrome (DS). DS is a rare disorder – caused by SCN1A mutations in 75% of cases – characterized by diverse types of severe epileptic seizures and several comorbidities such as cognitive impairment and behavioral problems. Behavioral problems largely impact the lives of DS patients and their caregivers and are also present – to a less severe extent – in non-DS patients (patients with GEFS+ or FS(+)). However, behavioral problems are often overlooked in the treatment of patients with SCN1A-related disorders. This study aimed to describe internalizing (e.g. depressed behavior) and externalizing (e.g. aggression) behavioral problems to investigate relations to possible risk factors in SCN1A-related seizure disorders both cross-sectionally and longitudinally. The population comprised of 161 Dutch patients, of which 113 DS patients and 48 non-DS patients. Behavioral data were obtained through digital surveys, behavioral questionnaires and phone interviews with (caregivers) of patients. Of 62 patients, complete longitudinal behavioral data from two measuring points – 2015 and 2021 – were collected. It was mainly hypothesized that behavioral problems related to high major seizure frequency and use of multiple anti-seizure medications and that increased behavioral problems over time were associated with multiple medication use, high seizure frequency and impaired cognition. Secondarily, factors such as cognitive impairment, sex differences and internalizing and externalizing problems were investigated. Expectedly, seizure frequency was positively related to behavioral problems in the whole population (rs = .249, p = .007). Unexpectedly, use of multiple anti-seizure medications was negatively associated with the presence of behavioral problems (X2 = 4.349, p = .037). In DS patients, being female and having severe cognitive impairment contributed to increased behavioral problems over time (R2 = .220). For non-DS patients, being of young age (R2 = .312) and female (R2 = .200) separately contributed to increased behavioral problems. This study facilitates improved education and active behavioral management of behavior problems for (family of) patients with SCN1A-related seizure disorders by identifying the prevalence and nature of behavioral difficulties and its associated factors.Show less
Psychosis affects one’s life on a symptomatic, functional, social and personal level. Cognitive insight and executive function are important predictors for the functional recovery of people with...Show morePsychosis affects one’s life on a symptomatic, functional, social and personal level. Cognitive insight and executive function are important predictors for the functional recovery of people with psychosis. Despite that, much research has been done on examining the association between executive function and cognitive insight, these constructs are still very complex and thus more research is required in advance of innovative interventions. Moreover, gender differences among people with psychosis may influence a possible association between executive function and cognitive insight. This cross-sectional study aimed to test whether executive function was associated with cognitive insight and whether gender did act as a moderator in a possible association between executive function and cognitive insight. It was expected that executive function was related to cognitive insight and that gender would moderate the association between executive function and cognitive insight. The data of 268 patients with psychosis from different mental health care institutions in the Netherlands were gathered by using the Behavior Rating Inventory of Executive Function-Adult Version and the Beck Cognitive Insight Scale. To measure executive function, the two indexes metacognition and behavior inhibition were used. The Spearman’s rank correlation coefficient indicated that executive function seemed to be associated with cognitive insight in people with psychosis (metacognition, rs = .171, p < .01; behavior inhibition, rs = .196, p < .01). In addition, a multiple regression analysis yielded no evidence for a moderating effect of gender on the association between executive function and cognitive insight (interaction effect of gender with metacognition (β = .13, 95% CI [-.09, .35]) and the interaction effect of gender with behavior inhibition (β = -.09, 95% CI [-.29, .09])). Future research should investigate similar studies with other nationalities, use both behavioral assessments and neuropsychological tasks on executive function, make use of an experimental design and make use of complementary questionnaires that are more reliable and less susceptible to response biases. The results of this study provide a base for therapeutics to adjust their interventions by seeking to sharpen self-reflectiveness, self-certainty and the executive functions to optimize the functional recovery of people with psychosis.Show less
Visuospatial neglect (VSN) is common in stroke patients. Associations between VSN and negative rehabilitation outcomes, as well as a higher age, have been found. Therefore, the aim of this...Show moreVisuospatial neglect (VSN) is common in stroke patients. Associations between VSN and negative rehabilitation outcomes, as well as a higher age, have been found. Therefore, the aim of this multicenter cross-sectional study was to investigate differences between older stroke patients with and without VSN, and whether a model can be developed to predict the probability of VSN diagnosis, in the geriatric rehabilitation setting. Data was collected from 114 stroke patients from their medical files, and participants were assessed on physical functional independence, cognitive impairment, pain, fatigue, and mood, and VSN was assessed using the Star cancellation test, Line bisection test, and Catherine Bergego Scale, within the first two weeks in geriatric rehabilitation. A t-test, Chi-square test, or Mann-Whitney U test was used to examine differences between participants with VSN and without VSN. Multivariable logistic regression was used to build a model of statistically significant independent predictors of VSN. Participants with VSN had longer length of stay in hospital (p = .005) and geriatric rehabilitation (p < .001), and a higher proportion of participants without VSN went home compared to participants with VSN (93.2% vs. 61.5%) (p < .001). Participants with VSN also had lower physical functional independence on the Utrecht Scale for Evaluation and Rehabilitation (p = .002), the Functional Ambulation Categories test (p = .006), and the Berg Balance Scale (p = .045), and higher cognitive impairment (p = .003). Length of stay at the geriatric rehabilitation (OR = 1.016, 95% CI [1.003, 1.030], B = .016, p = .018.) and discharge destination (OR = .206, 95% CI [.060, .714], B = -1.579, p = .013) were significant independent predictors of a higher likelihood of VSN diagnosis. The information from this study can be used to increase awareness of the impact of VSN on older stroke patients, and thereby improve underestimation of VSN and interventions targeted at VSN in these patients.Show less
