BACKGROUND: Recent attention has focused on the negative effects of chemotherapy on the cognitive performance of cancer survivors. The current study examined modification of this risk by catechol-O-methyltransferase (COMT) genotype based on evidence in adult populations that the presence of a Val allele is associated with poorer cognitive performance. METHODS: Breast cancer survivors treated with radiotherapy (n ¼ 58), and/or chemotherapy (n ¼ 72), and 204 healthy controls (HCs) completed tests of cognitive performance and provided saliva for COMT genotyping. COMT genotype was divided into Val carriers (Valþ; Val/Val, Val/Met) or COMT-Met homozygote carriers (Met; Met/ Met). RESULTS: COMT-Valþ carriers performed more poorly on tests of attention, verbal fluency, and motor speed relative to COMT-Met homozygotes. Moreover, COMT-Valþ carriers treated with chemotherapy performed more poorly on tests of attention relative to HC group members who were also Valþ carriers. CONCLUSIONS: The results suggest that persons treated with chemotherapy for breast cancer who also possess the COMT-Val gene are susceptible to negative effects on their cognitive health. This research is important because it strives to understand the factors that predispose some cancer survivors to more negative quality-of-life outcomes.
OBJECTIVES The effect of fear of falling (FoF) on recovery one year after hip fracture is not well known. Furthermore, the potential influence of premorbid function has not been explored. We aimed to describe rates of FoF after hip fracture, to assess the association of FoF with functional recovery one year post-fracture, and to evaluate the potential moderating effect of premorbid function on the relationship between FoF and functional recovery. DESIGN Secondary analysis of data from a prospective, longitudinal observational study to assess genetic factors influencing functional and psychological outcomes after hip fracture over 52 weeks. SETTING Eight area hospitals in St. Louis, MO. PARTICIPANTS 241 cognitively intact individuals 60 years of age or older requiring surgical repair for hip fracture. MEASUREMENTS Fear of falling was measured by the short Falls Efficacy Scale-International 4 and 12 weeks post-fracture. The primary outcome was probability of full recovery 52 weeks post-fracture assessed with the Functional Recovery Score. RESULTS High rates of FoF were seen at 4 (60.5%) and 12 weeks (47.0%) post-fracture. Week 12 FoF was associated with lower odds of recovery for those with high function pre-fracture, OR = 0.82 [0.72, 0.93], but not for those with impaired ADL performance, OR = 1.04 [0.91, 1.19]. CONCLUSION Fear of falling is common after hip fracture and is associated with poorer functional recovery one year after fracture, particularly in patients with high premorbid function. Fear of falling is a modifiable problem that represents a potential target for interventions to improve functional outcomes after hip fracture.
Background Hip fracture is often complicated by depressive symptoms in older adults. We sought to characterize trajectories of depressive symptoms arising after hip fracture and examine their relationship with functional outcomes and walking ability. We also investigated clinical and psychosocial predictors of these trajectories. Method We enrolled 482 inpatients, aged ≥60 years, who were admitted for hip fracture repair at eight St Louis, MO area hospitals between 2008 and 2012. Participants with current depression diagnosis and/or notable cognitive impairment were excluded. Depressive symptoms and functional recovery were assessed with the Montgomery–Asberg Depression Rating Scale and Functional Recovery Score, respectively, for 52 weeks after fracture. Health, cognitive, and psychosocial variables were gathered at baseline. We modeled depressive symptoms using group-based trajectory analysis and subsequently identified correlates of trajectory group membership. Results Three trajectories emerged according to the course of depressive symptoms, which we termed ‘resilient’, ‘distressed’, and ‘depressed’. The depressed trajectory (10% of participants) experienced a persistently high level of depressive symptoms and a slower time to recover mobility than the other trajectory groups. Stressful life events prior to the fracture, current smoking, higher anxiety, less social support, antidepressant use, past depression, and type of implant predicted membership of the depressed trajectory. Conclusions Depressive symptoms arising after hip fracture are associated with poorer functional status. Clinical and psychosocial variables predicted membership of the depression trajectory. Early identification and intervention of patients in a depressive trajectory may improve functional outcomes after hip fracture.
People with Parkinson's disease exhibit deficits in gait, speech and dexterity.• The usability of a mobile health (mHealth) smartphone application designed to target symptoms of gait, speech and dexterity in Parkinson's disease was investigated. • Primary outcome measures included adherence, gait characteristics, number of steps per day, sustained phonation, speech prosody and the 9-hole peg test. • Adherence to the mHealth application was moderate and there was little effect on gait, speech and dexterity.• Increased adherence to mHealth treatment was not associated with improved outcomes.• User-friendly mHealth to complement traditional rehabilitation may improve efficacy.Aim: This study investigated the usability of a mobile health (mHealth) smartphone application to treat gait, speech and dexterity in people with Parkinson's disease. Methods: Participants either used an mHealth application (intervention) or maintained their normal routine (control) for 12 weeks and were evaluated at baseline and post-test time points for primary outcome measures of adherence, gait, speech and dexterity. mHealth application adherence was compared with percent change scores on gait, speech and dexterity measures. Results: Adherence was moderate and there were no significant group, time or interaction effects for any outcome measures. Correlations between adherence and outcomes were weak and negative. Conclusion: These data suggest that usability of this mHealth application was limited as indicated by low adherence. The application alone in its present form was not adequate to treat symptoms of gait, speech or dexterity in people with Parkinson's disease.
Background and Purpose: Impaired gait, balance, and motor function are common in Parkinson disease (PD) and may lead to falls and injuries. Different forms of exercise improve motor function in PD, but determining which form of exercise is most effective requires a direct comparison of various approaches. In this prospective, controlled trial, we evaluated the impact of tango, treadmill walking, and stretching on gait, balance, motor function, and quality of life. We hypothesized tango and treadmill would improve forward walking and motor severity, and tango also would improve backward walking, balance, and quality of life. Methods: Ninety-six participants (age: 67.2±8.9 years, 42% female) with mild to moderate idiopathic PD were serially assigned to tango, treadmill walking, or stretching (active control group) and attended one-hour classes twice weekly for 12 weeks. Assessments occurred off anti-PD medication before and after the intervention and at follow-up 12 weeks after the intervention. Results: Forward velocity and backward velocity improved for the treadmill group from baseline to post-test and improvements persisted at follow-up. Backward velocity and motor functioning improved for the stretching group from baseline to post-test but results did not persist at follow-up. There were no significant changes in the tango group across time points. Discussion and Conclusions: Contrary to our hypotheses, only treadmill improved forward walking, while backward walking improved with treadmill and stretching. Future research should examine combinations of exercises with a focus on optimizing dosing and examining whether specific characteristics of people with PD correlate with different types of exercise. Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1)
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