Search Results for: Gestione delle complicanze psichiatriche e cognitive nel Parkinson

Background
Fathers are intricately bound to the experience of adolescent mothers and their children. Yet, fathers of children born to adolescent mothers, particularly within the context of HIV, remain neglected in the literature. These exploratory analyses provide insight into the characteristics of fathers of children born to adolescent mothers affected by HIV in South Africa.

Setting
Eastern Cape Province, South Africa.

Design
Cross-sectional data from a prospective cohort study.

Participants
Young mothers (10–24 years of age) and their children (0–68 months). All mothers completed detailed study questionnaires, including standardised and study-specific measures, relating to their self, their children and the fathers of their children. Summary statistics are presented based on maternal self-report of father characteristics. 2 tests and t-tests (Fisher’s exact/Kruskal-Wallis tests, where appropriate) were additionally used to explore sample characteristics (including father characteristics, maternal experience and child characteristics) according to paternal age and father involvement in childcare (defined by responses to four maternal self-report questions). Father characteristics were also explored according to maternal HIV status and maternal mental health status.

Results
40% of fathers were adolescents (10–19 years) at the birth of their children. Overall, father involvement was low (19.5%). Compared with noninvolved fathers, involved fathers were more likely to be older when their child was born (21 years vs 20 years, t=4.30, p=0.04), to be in a relationship with the mothers of their children (74.8% vs 47.2%, 2=40.8, p≤0.0001), to reside with their children and their mothers (14.7% vs 3.7%, 2=49.3, p≤0.0001) and to attend the first antenatal appointment (4.3% vs 1.5%, 2=5.21, p=0.02). A quarter (25.4%; 227/894) of the adolescent mothers in the sample were living with HIV. The prevalence of maternal HIV was found to be higher among adolescent mothers of children born to older fathers compared with adolescent fathers (31.7% vs 15.9%, 2=28.3, p≤0.001). Likewise, depressive symptoms were more prevalent among adolescent mothers of children born to older fathers compared with adolescent fathers (9.9% vs 5.3%, 2=6.08, p=0.01). Adolescent mothers reporting poor mental health were less likely to be in a relationship with the fathers of their children (41.8% vs 54.1%, 2=7.32, p=0.03) and more likely to experience domestic violence perpetrated by the fathers of their children (8.2% vs 3.3%, 2=6.07, p=0.01) and to engage in arguments about finances with the fathers of their children (30.0% vs 17.0%, 2=10.8, p=0.001). While some differences in individual subscales were identified, overall composite scores of child cognitive development did not differ according to father age or father involvement.

Conclusions
Analyses provide the first preliminary description of the fathers of children born to adolescent mothers affected by HIV in South Africa. Fathers are inherently tied to the experiences of adolescent mothers and their children. Father involvement with their children was low. Further research is required to explore the potential barriers to father involvement and pathways to overcome these. Efforts to bolster father engagement, such as the inclusion of fathers within maternal and child service provision, may have benefits for fathers, adolescent mothers and their children. There was a high prevalence of adolescent fatherhood in the study. Adolescent fathers may have specific needs requiring tailored intervention for adolescent parent families. The need for the inclusion of fathers within policy, programming and research remains.

Objectives
We aimed to explore the changes in oculomotor deficiencies during the follow-up of patients with multiple system atrophy (MSA) and Parkinson’s disease (PD), and to investigate the value of dynamic eye movement examination in their differential diagnosis.

Design
This was a cohort study conducted from 2017 to 2023.

Setting
The Movement Disorders Clinic at a tertiary hospital in Beijing, China.

Participants
56 patients with PD and 13 patients with MSA from an initial cohort of over 1100 with parkinsonism were included in the final longitudinal analysis.

Outcome measures
Multisystem evaluations were performed at baseline. Videonystagmography (VNG) was repeated to assess oculomotor dysfunction at baseline and during follow-up. Abnormalities in the fixation and gaze-holding test, without-fixation test, reflexive and memory-guided saccade tests, smooth pursuit test and optokinetic test were qualitatively and quantitatively recorded and statistically analysed.

Results
The median follow-up time of MSA (16 months) was significantly shorter than that of PD (27 months). In MSA, the incidence of abnormalities in fixation and gaze-holding tests (0% vs 30.8%, p=0.030), reflexive saccade tests (46.2% vs 84.6%, p=0.039, with slow saccades increasing from 7.7% to 46.2%, p=0.027) and smooth pursuit tests (38.5% vs 76.9%, p=0.047) increased significantly from baseline to the end of follow-up. In PD, no significant changes were revealed during follow-up.

Conclusions
MSA exhibited more rapid and prominent changes in fixation and gaze-holding tests, reflexive saccades and smooth pursuit tests than PD. Dynamic observation of oculomotor function may aid in the differential diagnosis of Parkinson’s syndrome.

Introduction
Pain is one of the most bothersome symptoms that affects patients with inflammatory bowel disease (IBD) but is often inadequately treated. Inadequate pain control in the inpatient setting not only impacts patients’ experience but increases opioid use and hospital length of stay. Opioids are often considered first-line treatment for severe pain but are associated with significant morbidity and mortality in IBD. Non-steroidal anti-inflammatory drugs are a non-opioid analgesic option, but concerns regarding their contribution to IBD flares have limited their use. Brain-gut behavioural therapies (BGBT), such as cognitive behavioural therapy, meditation and gut-directed hypnotherapy, are effective for pain management and have a role in the treatment of IBD symptoms. However, the use of BGBT in IBD is challenging, given limited access to behavioural health specialists, especially in the inpatient setting. Virtual reality (VR)-directed BGBT programmes can bridge this gap and enhance pain treatment for inpatients with IBD. Therefore, in this study, we aim to establish feasibility and acceptability for a VR-directed BGBT inpatient programme for patients with IBD.

Methods and analysis
We will recruit 40 patients with IBD who are hospitalised at Michigan Medicine and who endorse IBD-related pain. We will assess patient-reported outcomes (pain rating, IBD-specific symptoms, perceived stress, mood) before and after treatment, cumulative inpatient analgesic requirements and hospital length of stay. Our primary objective will be to establish intervention feasibility defined by the frequency and percentage of enrolled participants that use the VR-directed BGBT inpatient intervention in any capacity. Our secondary objective will be to evaluate intervention acceptability by conducting semistructured interviews with study participants. We will also explore the preliminary effectiveness of VR-directed BGBT on patient-reported outcomes and healthcare utilisation as compared with historic controls.

Ethics and dissemination
The study was approved by the institutional review board of the University of Michigan Medical School on 10 October 2023 (HUM00240999). All human subjects will be required to sign an informed consent document prior to study participation. Study findings will be reported through peer-reviewed publication.

Trial registration number
NCT06188793.

Introduction
Major depressive disorder (MDD) is a major global healthcare challenge. This is, in part, due to the lack of treatment response and chronic course of MDD. Such a course of illness is often termed treatment-resistant depression (TRD) and is seen in over one-third of people with MDD. Reasons for treatment resistance are not well established, nor is the definition of TRD. Duration and severity of depression, however, are associated with TRD and are also associated with cognitive deficits. Thus, TRD could be particularly prone to cognitive deficits and at heightened risk for neuroprogression. While the cognitive profile of MDD has been investigated in several systematic reviews, no systematic review of cognition in TRD exists to date. The present study will fill this gap in the literature. It is expected that TRD will show more severe cognitive deficits than generally reported in MDD and deficits in all cognitive functions are expected.

Methods and Analysis
A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be performed of the databases Embase, Pubmed/MEDLINE, PsychINFO and Cochrane including peer-reviewed studies on humans using standardised cognitive tests. Pilot searching was performed in January 2025 and the full search will be commenced in June 2025, with additional searches following completion. Where sufficient data are reported, a meta-analysis comparing deficits in TRD with MDD and healthy control participants will be performed; alternatively, effects based on norms will be calculated. Meta-regression, subgroup and sensitivity analyses will be conducted to explore moderators that are sufficiently reported in the literature. The quality of studies will be assessed by the Newcastle-Ottawa Scale.

Ethics and dissemination
Ethical approval is not necessary to perform the study, and results will be presented at a suitable conference and published in a peer-reviewed journal.

Prospero registration number
CRD42024538898.

Introduction
Cerebral palsy (CP), the most common physical disability in children, imposes substantial economic and psychological burdens on families and society. The clinical management of CP remains challenging due to the limited efficacy of current treatments and the heterogeneity of its aetiologies and clinical presentations. This study aims to investigate the functional changes and identify influencing factors in Chinese children with CP. Through analysis of neuroimaging and genetic data, this study seeks to inform the development of preventive and therapeutic strategies and guide healthcare decision-making for this population.

Methods and analysis
This prospective cohort study aims to recruit 2051 children with CP across China. Baseline data will include demographic and clinical characteristics. Participants will undergo comprehensive assessments, including motor, cognitive, language, social, behavioural, nutritional, pain, sleep and quality-of-life domains, with regular follow-up evaluations. Trio whole-exome sequencing and detailed neuroimaging and musculoskeletal imaging will also be performed. This study will also assess caregivers’ quality of life and emotional burden. Mendelian randomisation will be adopted to evaluate genetic contributions to functional outcomes and their causal relationship with health metrics. Analytical methods will include correlation analysis, logistic regression (binary and multivariate), linear and non-linear mixed-effects models and structural equation modelling.

Ethics and dissemination
Ethics approval was granted by the Research Ethics Committee of Guangzhou Women and Children’s Medical Center (No.2023-346A01). All study procedures will adhere to the approved protocol. Study findings will be disseminated through peer-reviewed publications and conference presentations.

Trial registration number
ChiCTR2300079017.

This randomized clinical trial examines the relative effect of 4 classes of glucose-lowering medications that were randomly added to metformin on cognitive performance in persons with type 2 diabetes of short duration.

This systematic review and meta-analysis examines data for patients with diabetes and/or obesity from trials of GLP1-RA treatment to evaluate psychiatric, cognitive, and quality-of-life outcomes compared with placebo.

Delirium affects one-third of hospitalized older adults and is associated with prolonged length of stay, institutional discharge, long-term functional and cognitive decline, Alzheimer disease and related dementias (AD/ADRD), and death. Moreover, the costs of delirium exceed $182 billion annually in the US alone. Despite these compelling data, accurate identification of delirium remains challenging, with more than half of delirium going unrecognized in routine care. While delirium prevention has advanced substantially, delirium treatment, which relies on early and accurate identification, lags. More than 40 tools are available for delirium assessment, ranging from short structured screens to in-depth reference standards. Evidence on how to implement these tools to improve delirium identification at the bedside, including which tool to use, who should administer it, how often, and how to educate and engage the care team, remains limited.

In JAMA Internal Medicine, Luchsinger et al describe the results of a prespecified secondary analysis of the GRADE clinical trial on cognitive performance. The GRADE trial randomized 3721 patients with type 2 diabetes using metformin at baseline to add either a long-acting insulin, a sulfonylurea, a glucagon-like peptide-1 (GLP-1) agonist, or a dipeptidyl peptidase-4 inhibitor. At 4 years following randomization, cognitive performance was not different between treatment groups across 3 validated cognitive tests. However, worsened glycemic control was associated with modestly lower cognitive test scores. These findings provide important data for clinicians, particularly in light of recent lay press and scientific enthusiasm about GLP-1 agonists for dementia prevention.

This Viewpoint examines the use of blood-based biomarkers to test for Alzheimer disease and outlines why they should not be the first or only tool used in screening for cognitive impairment.

Per la fase avanzata. Al San Carlo di Potenza

Introduction
Cognitive frailty (CF) is a clinical syndrome characterised by the concurrent occurrence of physical frailty and cognitive impairment, excluding Alzheimer’s disease and other forms of dementia. Recent studies have shown that combining aerobic exercise (AE) and meditation (ME) effectively enhances both physical and cognitive functions in individuals with CF. The study aims to determine whether the combined application of AE and ME can elicit significantly greater improvements in physical and cognitive functions among individuals with CF compared with the independent practice of either AE or ME alone.

Methods and analysis
The research design employs a four-arm, assessor-blind randomised controlled trial. A total of 140 qualified subjects will be randomly allocated among four groups: AE, ME, AE combined with ME and a health education control group, ensuring equivalent distribution across groups. The intervention phase of the study will last for 12 weeks. The primary outcomes will include the Edmonton Frailty Scale, while secondary outcomes will encompass evaluations of cognitive functions (including global cognitive function, memory, attention, executive function and visuospatial abilities), physical performance (measured by gait speed and lower extremity strength), subjective experiences (such as fatigue, quality of life, mindfulness, mood and sleep quality), as well as structural and functional MRI assessments and serum biomarkers. Outcomes will be evaluated at baseline and following the 12-week intervention.

Ethics and dissemination
The Ethics Committee of the Affiliated Rehabilitation Hospital of the Fujian University of Traditional Chinese Medicine granted ethical approval for the study (2023KY-012–02). The findings will be disseminated through publications in peer-reviewed journals and presentations at academic conferences.

Trial registration number
ChiCTR2300073563.

Objectives
Patient and public involvement (PPI) was sought in the development of the protocol for the Cognitive Decline after Brain Radiosurgery (CoDe B-Rad) study, which aims to identify potential side effects of stereotactic radiosurgery (SRS). PPI served to refine the research question and methodology.

Design
PPI.

Setting
PPI conducted online with people based in the UK. The CoDe B-Rad study is running in regional National Health Service tertiary care in the UK and is currently nearing recruitment completion.

Participants
Patients and carers with lived experiences of brain radiotherapy. Contributors were identified through national charities.

Procedures
Initial focus groups were planned, but participation proved challenging. Instead, online questionnaires, one-to-one discussions and participation in support groups were completed.

Results
All contributors experienced changes to their cognition and/or quality of life (QoL) after radiotherapy. Quantifying the side effects of SRS and minimising them were identified as a research gap. Discussion group participation proved challenging. PPI plans were altered to accommodate the physical and mental needs of contributors. It was decided to combine the Montreal Cognitive Assessment along with European Organisation for Research and Treatment in Cancer QLQ-C30 and BN20 to capture cognitive status and QoL of patients with brain metastases and meningiomas after SRS. Patients/carers recommended for sessions to be restricted to 30 min and testing to be offered face-to-face, online, in hospital or at patients’ homes. Coproduction was not achievable with our patient population but that did not diminish the input of contributors nor the impact it had on designing the study protocol.

Conclusions
In cancer research, diligent considerations are required to ensure the suitability of involvement methods for this vulnerable population. Flexibility and adaptability of draft PPI plans are essential to achieve meaningful contributions. The protocol of the ongoing CoDe B-Rad study was positively shaped by people with lived experiences of brain radiotherapy.

Trial registration number
NCT06466720 (CoDe B-Rad study).

Background
Head and neck cancer (HNC) represents a prevalent category of malignant tumours, with disease-associated and treatment-associated symptoms often resulting in significant complications that adversely impact patient quality of life. Effective self-management during treatment and rehabilitation is crucial for mitigating or delaying the onset of these symptoms. While existing studies have investigated various aspects of self-management, including its content, influencing factors and specific strategies for managing symptom burden in HNC survivors, no comprehensive study of the self-management experience in this patient population has hitherto been conducted.

Objective
This study aimed to systematically synthesise evidence on the content, experiences, barriers and facilitators of self-management among patients with HNC, with the ultimate goal of informing tailored self-management interventions.

Design
A systematic review of qualitative studies was conducted using a meta-aggregation approach.

Methods
A three-step search strategy was implemented to systematically review eight databases, including PubMed, Web of Science, CINAHL and Embase, from inception to June 2024. This review concentrated on studies examining the content of self-management for patients with HNC during treatment and rehabilitation, identifying both facilitators and barriers and delineating empirical self-management strategies. Two researchers independently screened the literature and performed quality assessments using the Joanna Briggs Institute qualitative research evaluation tool. Subsequently, data extraction was conducted to collect pertinent information. This qualitative systematic review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement.

Results
A total of 3263 studies were identified, of which 15 met the inclusion criteria and were subsequently incorporated into the meta-synthesis. This integration revealed 3 primary themes and 10 subthemes, specifically: (1) the management of disease-related and treatment-related symptoms and functional alterations in HNC, exploring self-management strategies such as coping with and monitoring physical and mental symptoms and adjusting to modifications in fundamental operations; (2) barriers and facilitators in the integration process of self-management, including psychological, emotional and cognitive disorders, the impact of symptom burden on patients’ motivation and capacity for self-management, structural impediments and facilitators; and (3) challenges in incorporating self-management into daily life and strategies for effective implementation, encompassing acceptance and adaptation as strategies for coping and thriving, proactive issue resolution, self-motivation and the employment of a diverse array of targeted strategies emphasising recovery.

Conclusions
Patients diagnosed with HNC must engage in extensive self-management throughout diagnosis and treatment, encountering numerous challenges when integrating self-management practices into their daily lives. Despite the numerous challenges encountered, patients with HNC continue to endeavour to incorporate self-management strategies into their daily routines. Future research could leverage these insights to further investigate and delineate the essential elements and effective components of self-management and design targeted self-management interventions tailored for this patient population.

PROSPERO registration number
CRD42022365704.

Introduction
Type 1 diabetes (T1D) is associated with changes in brain structure, cognition, mental health, and functional outcomes. While these changes have been linked to dysregulated glycaemic control, findings are inconsistent, and their long-term impact remains unclear. Most evidence comes from cross-sectional or short-term longitudinal studies, limiting insights into causal associations. To address this, we aim to study individuals with T1D approximately 30 years after onset to assess how early dysglycaemic insults during neurodevelopment influence cognitive and functional outcomes in mid-adulthood.

Methods and analysis
This protocol paper outlines an observational, case/control, cross-sectional/longitudinal and descriptive study that follows up the original Royal Children’s Hospital (RCH) Diabetes Cohort Study. The initial study recruited children in Australia diagnosed with T1D between 1990 and 1992, conducting five waves of data collection. We now introduce the Cognition and Longitudinal Assessments of Risk Factors over 30 Years (CLARiFY) Diabetes Complications Study to assess brain, cognition and functional outcomes in mid-adulthood, approximately 30 years post-T1D onset. Both T1D participants from the original cohort and healthy controls will participate in semistructured interviews, neuroimaging and cognitive testing. T1D participants will also undergo complications screening. Data from this study and previous waves will be used to (Aim 1) explore cross-sectional and longitudinal impacts of T1D on brain health over 30 years. Linear regression will analyse cross-sectional outcomes, and multivariate analysis will assess cognitive variables jointly. Longitudinal outcomes will be examined using linear mixed-effects regression for IQ patterns, with secondary outcomes analysed via generalised linear models. Additionally, linear mixed-effects regression (Aim 2) will identify T1D-related metabolic factors affecting brain outcomes, with covariate selection informed by the construction of directed acyclic graphs (DAGs).

Ethics and dissemination
The study was approved by the Royal Children’s Hospital Human Research Ethics Committee (HREC 35 240F and 2019.065). The research findings will be disseminated through peer-reviewed publications, conference presentations, and print and social media. Participants will receive a summary of the study findings on its completion.