Bakgrund: Bröstcancer ökar för varje år och detta leder i sin tur till att fler överlever sin diagnos. Vid behandling av bröstcancer är en av behandlingsmetoderna kemoterapi som i sin tur kan ge biverkningar såsom fatigue och kognitiv nedsättning. Dessa symtom kan påverka och försvåra vardagen för bröstcancerpatienter. Syfte: Att beskriva bröstcancerpatienters upplevelse av kemoterapi med avseende på fatigue och kognitiv nedsättning samt hur dessa symtom påverkade det vardagliga livet.  Metod: Litteraturöversikt baserad på tio vetenskapliga artiklar med kvalitativ metod som valdes ut genom sökning i CINAHL och PsycInfo. Resultat: Totalt sju kategorier identifierades; Upplevelse av symtomet, Tankar och känslor väckta av symtomupplevelsen, Prövningar i vardagen, Arbetslivets utmaningar, Relationer i kris, Strategier för hantering samt Erfarenheter av sjukvården och deras roll. Kvinnorna kände att de inte fick någon information eller bekräftelse från sjukvården angående kognitiv nedsättning som biverkan av kemoterapi före behandlingen. Kognitiv nedsättning och fatigue påverkade många kvinnor i arbetslivet, deras arbetsprestationer samt deras vardagsliv i olika utsträckning. Kvinnorna efterfrågade olika insatser från hälso- och sjukvården för att hantera symtomen. Hantering av biverkningar skiljde sig åt mellan kvinnorna och deras strategier påverkades av symtomet samt deras mentalitet. Slutsats: Omvårdnadsinsatser samt information om fatigue och kognitiv nedsättning på grund av kemoterapi behöver utvecklas i sjukvården. Det behövs mer forskning för att fylla den kunskapslucka som finns angående kognitiv nedsättning. / Background: Breast cancer increases every year, and this leads to that more women survive their diagnosis. One of the treatment methods that is used is chemotherapy, which can cause side effects such as fatigue and cognitive impairment. These symptoms can impact and complicate the every-day life of breast cancer patients.  Aim: To describe the experience of chemotherapy considering fatigue and cognitive impairment and the impact of every-day life among breast cancer patients. Method: Literature review based on ten qualitative scientific articles. CINAHL and PsycInfo were chosen as databases. Result: A total of seven categories were identified; Symptom experience, Thoughts and feelings awoken by the symptom experience, Challenges in everyday life, Challenges in work life, Relationships in crisis, Management strategies, and Experiences of health care. Women felt that they did not receive any information about cognitive impairment as a side effect of chemotherapy before the treatment. The side effects affected their working life, job performance and their every-day life to varying extent. The women requested different support systems from the health care to help them manage these symptoms. The coping mechanisms differed among the women and the strategies depended upon the symptom and the women’s mentality.  Conclusion: There is a need to improve nursing and information in health care, regarding negative side effects of chemotherapy as fatigue and cognitive impairment. There is a need for more in-depth research to fill the knowledge gap concerning cognitive impairment.

Background: The impact of genetic polymorphisms on cognition is assumed to increase with age as losses of brain resources have to be compensated for. We investigate the relation of catechol-O-methyltransferase (COMT) p.Val158Met polymorphism and cognitive capacity in the course of adult development, healthy aging and the development of mild cognitive impairment (MCI) in two birth cohorts of subjects born between 1930 and 1932 or between 1950 and 1952. Methods: Thorough neuropsychological assessment was conducted in a total of 587 participants across three examination waves between 1993 and 2008. The COMT genotype was determined as a restriction fragment length polymorphism after PCR amplification and digestion with Nla III. Results: Significant effects of the COMT p.Val158Met polymorphism were identified for attention and cognitive flexibility in the younger but not the older cohort. Conclusion: These results confirm the importance of the COMT p.Val158Met genotype on tasks assessing attention and cognitive flexibility in midlife but not in healthy aging and the development of MCI. Our findings suggest that the influence of COMT changes as a function of age, decreasing from midlife to aging.

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Yes / To determine whether or not jugular venous reflux (JVR) is associated with structural brain parenchyma changes in individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD). 16 AD patients (mean (SD): 81.9 (5.8) years), 33 MCI patients (mean (SD): 81.4 (6.1) years) and 18 healthy elderly controls (mean (SD): 81.5 (3.4) years) underwent duplex ultrasonography and magnetic resonance imaging scans to quantify structural brain parenchyma changes. Normalized whole brain (WB), gray matter (GM) and white matter (WM) volumes were collected, together with CSF volume. JVR was strongly associated with increased normalized WB (p = 0.014) and GM (p = 0.002) volumes across all three subject groups. There was a trend towards increased WB and GM volumes, which was accompanied by decreased CSF volume, in the JVR-positive subjects in both the MCI and AD groups. When the MCI and AD subjects were aggregated together significant increases were observed in both normalized WB (p = 0.009) and GM (p = 0.003) volumes for the JVR-positive group. No corresponding increases were observed for the JVR-positive subjects in the control group. Through receiver operating characteristic analysis of the brain volumetric data it was possible to discriminate between the JVR-positive and negative AD subjects with reasonable accuracy (sensitivity = 71.4%; specificity = 88.9%; p = 0.007). JVR is associated with intracranial structural changes in MCI and AD patients, which result in increased WB and GM volumes. The neuropathology of this unexpected and counterintuitive finding requires further investigation, but may suggest that JVR retrogradely transmits venous hypertension into the brain and leads to brain tissues swelling due to vasogenic edema.

<p dir="ltr">Over 50% of ambulatory older adults administer at least one anticholinergic medication. Older adults may be more susceptible to the adverse effects of anticholinergic medications, and there is evidence showing an association between anticholinergic exposure and increased risk of dementia. The primary objective of this research is to assess the impact of one-year of prescriptions for strong anticholinergics, with a score of 2 or 3 on the Anticholinergic Cognitive Burden (ACB) Scale, on cognitive measures indicative of dementia, followed by a comparative assessment of the relative impact of medication classes with anticholinergic activity.</p><p dir="ltr">The study utilizes a retrospective observational design to evaluate the relationship between anticholinergic medication prescriptions and cognitive measures. We used one-year EMR prescription data gleaned from R2D2 and BrainSafe clinical trials’ participants prior to baseline for the exposure variable along with the cognitive measures captured at the baseline visit. Total Standardized Daily Dose (TSDD) was computed from prescription records to quantify exposure to strong anticholinergics. Generalized Linear Models and Least Square means with Tukey’s adjustment were computed to detect the relationship between anticholinergic TSDD and anticholinergic medication classes and cognitive measures in multiple models.</p>

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Bakgrund: Anestesi- och operationssjuksköterskor kommer under sitt arbete möta patienter med någon form av kognitiv nedsättning. Specialistsjuksköterskor inom den perioperativa miljön har en skyldighet att erbjuda individanpassad omvårdnad till patienter med kognitiv nedsättning. Den perioperativa dialogen är ett sätt för patienten och närstående att bli införstådda i vårdsituationen och för specialistsjuksköterskor ett verktyg för att få adekvat information om patientens önskemål. Syfte: Syftet var att beskriva anestesi- och operationssjuksköterskors erfarenheter av att vårda patienter med kognitiv nedsättning inom den perioperativa vården. Metod: I studien användes en kvalitativ metod med en induktiv ansats. Sex anestesisjuksköterskor och fyra operationssjuksköterskor intervjuades och det insamlade materialet analyserades med kvalitativ innehållsanalys. Resultat: Analysprocessen resulterade i tre kategorier. Dessa var: “samverkan i team”, “behov av resurser och hjälpmedel” och “behov av individanpassat bemötande och kommunikation”, samt 14 subkategorier. Konklusion: Studien visade att omhändertagande av patienter med kognitiv nedsättning inom den perioperativa miljön var en utmaning. Den perioperativa vården kan anpassas efter patientens särskilda behov genom närståendes delaktighet, ett professionellt samarbete i team samt ett personcentrerat förhållningssätt. / Background: Anesthesia- and operating nurses´ will encounter patients with some form of cognitive impairment during their work. Perioperative specialist nurses have a duty to provide individualized care for patients with cognitive impairment. The perioperative dialogue is a way for patients and their relatives to understand the health situation, and for specialist nurses, it serves as a tool to gather adequate information about the patient's preferences. Aim: The aim was to describe the experiences of anesthesia- and operating nurses´ in caring for patients with cognitive impairment within perioperative care. Method: A qualitative method with an inductive approach was used in the study. Six anesthesia nurses and four surgical nurses were interviewed, and the collected material was analyzed using qualitative content analysis. Results: The analysis process resulted in three categories: "team collaboration", "need for resources and aids" and "need for individualized approach and communication", along with 14 subcategories. Conclusion: The study revealed that caring for patients with cognitive impairment in the perioperative environment posed a challenge. The perioperative care can be adapted to the patient's specific needs through the involvement of close relatives, professional teamwork, and a person-centered approach.

One particular challenge of brain connectomics deals with inferring differences in the brain due to diseases such as Alzheimer's. More specifically, structural connectomics aims at investigating the connectivity between regions in the brain based on the distribution of neuronal fibers. The first step in generating structural connectomes is to perform tractography reconstruction on diffusion MRI (dMRI) data, to extract the most likely pathways of neural fibers. However, current tractography reconstruction algorithms suffer from having high sensitivity and low specificity. Thus, the following steps  of creating, analyzing and deriving graphs metrics from connectivity maps based on tractography impair the reliable assessment of structural connectivity. A promising method to improve tractography and subsequent structural connectomes is to apply tractogram filtering methods. In this study, the impact of tractogram filtering on structural connectomics and derived graph measures of subjects with mild cognitive impairment (MCI), specifically using spherical-deconvolution informed filtering of tractograms (SIFT), is experimentally examined. Moreover, the study also aims at inferring the effects of tractogram filtering in machine-learning based classification of the aforementioned structural connectomes. The pipeline in this experimental setup uses registration tools from FSL, tractography tools from MRTrix3Tissue as well as Keras for classification. The results from the given experiments show, that graph measures such as nodestrength and betweenness centrality are altered for the individual nodes. This leads to new connectomes with nodes, which are more important after tractogram filtering. This effect was also seen in connectomes weighted by fractional anisotropy (FA), mean diffusivity (MD) and radial diffusivity (RD). Moreover, structural connectomes based on filtered tractograms yield a higher classification performance. The best classification performance was reached with 88.65% on raw connectomes. Limiting factors in this experimental setup are identified as the small number of subjects at hand and computation time and the errors introduced by image registration and tractography parameterization.

Research has demonstrated that everyday functional abilities are compromised in mild cognitive impairment (MCI), a transitional stage between normal cognitive aging and dementia, as well as in healthy aging. These functional changes have been shown to be strong predictors of future decline, highlighting their importance. However, early changes in everyday functioning remain poorly characterized, largely due to a scarcity of sensitive measures capable of detecting subtle disruption. Recent research suggests that eye-tracking methodology may be effective in addressing this gap. Fifty-two participants (27 younger adults and 25 non-demented older adults) completed a novel eye-tracking task involving passive viewing of a naturalistic scene and verbalization of a task goal (e.g., make coffee, pack a lunch). Participants also completed a performance-based measure of everyday action that required them to enact the same tasks (e.g., coffee, lunch) that were included in the eye-tracking paradigm, self-report measures of functional ability, and neuropsychological measures. Mixed ANOVAs were conducted to examine group (young, old) and condition (passive viewing, verbalization)/task (simple, complex) effects on eye-tracking and everyday action performance. Independent samples t-tests/Mann-Whitney U tests were conducted to examine group differences in eye-tracking and everyday action performance. Correlation analyses across all measures were conducted to evaluate the potential mechanisms of eye-tracking and everyday action results. Results showed no significant group differences in the primary eye-tracking variables, but both groups made a lower proportion of fixations to distractor (i.e., non-target) objects during task verbalization compared to passive scene viewing. Older adults made more inefficient actions during performance-based everyday task completion, particularly when task demands were high. Eye tracking and everyday action variables were related to different measures of self-reported functional ability. Finally, eye-tracking variables were primarily related to neuropsychological measures of executive functions/working memory, whereas everyday action performance was most strongly related to measures of verbal learning and memory. These findings suggest that age-related functional changes at the level of eye movements may occur after changes in behavioral performance of everyday tasks. Importantly, performance-based assessment of everyday action appears sensitive to age-related decline. Additionally, naturalistic eye movements and everyday task performance may reflect distinct components of self-reported functioning and may be driven by distinct cognitive processes. Future research with refined naturalistic eye-tracking tasks and samples with a wider range of impairment is necessary to further explore these findings and improve characterization and detection of risk for dementia. / Psychology