Posts Tagged Neurodegenerative Diseases

[A CLINICAL PRACTICE GUIDELINE] A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation

Background: Use of outcome measures (OMs) in adult neurologic physical therapy is essential for monitoring changes in a patient’s status over time, quantifying observations and patient-reported function, enhancing communication, and increasing the efficiency of patient care. OMs also provide a mechanism to compare patient and organizational outcomes, examine intervention effectiveness, and generate new knowledge. This clinical practice guideline (CPG) examined the literature related to OMs of balance, gait, transfers, and patient-stated goals to identify a core set of OMs for use across adults with neurologic conditions and practice settings.

Methods: To determine the scope of this CPG, surveys were conducted to assess the needs and priorities of consumers and physical therapists. OMs were identified through recommendations of the Academy of Neurologic Physical Therapy’s Evidence Database to Guide Effectiveness task forces. A systematic review of the literature on the OMs was conducted and additional OMs were identified; the literature search was repeated on these measures. Articles meeting the inclusion criteria were critically appraised by 2 reviewers using a modified version of the COnsensus-based Standards for the selection of health Measurement INstruments. (COSMIN) checklist. Methodological quality and the strength of statistical results were determined. To be recommended for the core set, the OMs needed to demonstrate excellent psychometric properties in high-quality studies across neurologic conditions.

Results/Discussion: Based on survey results, the CPG focuses on OMs that have acceptable clinical utility and can be used to assess change over time in a patient’s balance, gait, transfers, and patient-stated goals. Strong, level I evidence supports the use of the Berg Balance Scale to assess changes in static and dynamic sitting and standing balance and the Activities-specific Balance Confidence Scale to assess changes in balance confidence. Strong to moderate evidence supports the use of the Functional Gait Assessment to assess changes in dynamic balance while walking, the 10 meter Walk Test to assess changes in gait speed, and the 6-Minute Walk Test to assess changes in walking distance. Best practice evidence supports the use of the 5 Times Sit-to-Stand to assess sit to standing transfers. Evidence was insufficient to support use of a specific OM to assess patient-stated goals across adult neurologic conditions. Physical therapists should discuss the OM results with patients and collaboratively decide how the results should inform the plan of care.

Disclaimer: The recommendations included in this CPG are intended as a guide for clinicians, patients, educators, and researchers to improve rehabilitation care and its impact on adults with neurologic conditions. The contents of this CPG were developed with support from the APTA and the Academy of Neurologic Physical Therapy (ANPT). The Guideline Development Group (GDG) used a rigorous review process and was able to freely express its findings and recommendations without influence from the APTA or the ANPT. The authors declare no competing interest.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A214.

TABLE OF CONTENTS

  • INTRODUCTION AND METHODS
  • Levels of Evidence and Grades of Recommendations ………………………………………………..178
  • Summary of Action Statements ………………………………………………..179
  • Introduction ………………………………………………..181
  • Methods ………………………………………………..182
  • OUTCOME MEASURE RECOMMENDATIONS
  • The Core Set of Outcome Measures for Neurologic Physical Therapy ………………………………………………..191
  • Action Statement 1: Static and Dynamic Sitting and Standing Balance Assessment ………………………………………………..191
  • Action Statement 2: Walking Balance Assessment ………………………………………………..195
  • Action Statement 3: Balance Confidence Assessment ………………………………………………..197
  • Action Statement 4: Walking Speed Assessment ………………………………………………..199
  • Action Statement 5: Walking Distance Assessment ………………………………………………..203
  • Action Statement 6: Transfer Assessment ………………………………………………..207
  • Action Statement 7: Documentation of Patient Goals ………………………………………………..208
  • Action Statement 8: Use of the Core Set of Outcome Measures ………………………………………………..209
  • Action Statement 9: Discuss Outcome Measure Results and Use
  • Collaborative/Shared Decision-Making With Patients ………………………………………………..211
  • Guideline Implementation Recommendations ………………………………………………..212
  • Summary of Research Recommendations ………………………………………………..215
  • ACKNOWLEDGMENTS AND REFERENCES
  • Acknowledgments ………………………………………………..217
  • References ………………………………………………..217
  • TABLES
  • Table 1: Levels of Evidence ………………………………………………..178
  • Table 2: Grades of Recommendations ………………………………………………..178
  • Table 3: Outline of the CPG Process ………………………………………………..183
  • Table 4: Inclusion and Exclusion Criteria for Article Review ………………………………………………..187
  • Table 5: COSMIN Ratings for Strength of Statistics ………………………………………………..189
  • Table 6: Process Used to Make Recommendations ………………………………………………..190
  • Table 7: Evidence Table, Berg Balance Scale ………………………………………………..192
  • Table 8: Evidence Table, Functional Gait Assessment ………………………………………………..196
  • Table 9: Evidence Table, Activities-specific Balance Confidence ………………………………………………..198
  • Table 10: Evidence Table, 10 meter Walk Test ………………………………………………..201
  • Table 11: Evidence Table, 6-Minute Walk Test ………………………………………………..205
  • Table 12: Evidence Table, 5 Times Sit-to-Stand ………………………………………………..208

[…]

Continue —>  A Core Set of Outcome Measures for Adults With Neurologic Co… : Journal of Neurologic Physical Therapy

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[WEB SITE] Antiepileptic drug use linked to increased risk of Alzheimer’s and dementia

The use of antiepileptic drugs is associated with an increased risk of Alzheimer’s disease and dementia, according to a new study from the University of Eastern Finland and the German Center for Neurodegenerative Diseases, DZNE. Continuous use of antiepileptic drugs for a period exceeding one year was associated with a 15 percent increased risk of Alzheimer’s disease in the Finnish dataset, and with a 30 percent increased risk of dementia in the German dataset.

Some antiepileptic drugs are known to impair cognitive function, which refers to all different aspects of information processing. When the researchers compared different antiepileptic drugs, they found that the risk of Alzheimer’s disease and dementia was specifically associated with drugs that impair cognitive function. These drugs were associated with a 20 percent increased risk of Alzheimer’s disease and with a 60 percent increased risk of dementia.

The researchers also found that the higher the dose of a drug that impairs cognitive function, the higher the risk of dementia. However, other antiepileptic drugs, i.e. those which do not impair cognitive processing, were not associated with the risk.

“More research should be conducted into the long-term cognitive effects of these drugs, especially among older people,” Senior Researcher Heidi Taipale from the University of Eastern Finland says.

Besides for epilepsy, antiepileptic drugs are used in the treatment of neuropathic pain, bipolar disorder and generalized anxiety disorder. This new study is the largest research on the topic so far, and the first to investigate the association in terms of regularity of use, dose and comparing the risk between antiepileptic drugs with and without cognitive-impairing effects. The results were published in the Journal of the American Geriatrics Society.

The association of antiepileptic drug use with Alzheimer’s disease was assessed in Finnish persons diagnosed with Alzheimer’s disease and their controls without the disease. This study is part of the nationwide register-based MEDALZ study, which includes all 70,718 persons diagnosed with Alzheimer’s disease in Finland during 2005-2011 and their 282,862 controls. The association of antiepileptic drug use with dementia was investigated in a sample from a large German statutory health insurance provider, Allgemeine Ortskrankenkasse (AOK). The dataset includes 20,325 persons diagnosed with dementia in 2004-2011, and their 81,300 controls.

via Antiepileptic drug use linked to increased risk of Alzheimer’s and dementia

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[Abstract] The Impact of Traumatic Brain Injury on Later Life: Effects on Normal Aging and Neurodegenerative Diseases

ABSTRACT

The acute and chronic effects of traumatic brain injury (TBI) have been widely described; however, there is limited knowledge on how a TBI sustained during early adulthood or mid-adulthood will influence aging. Epidemiological studies have explored whether TBI poses a risk for dementia and other neurodegenerative diseases associated with aging. We will discuss the influence of TBI and resulting medical comorbidities such as endocrine, sleep, and inflammatory disturbances on age-related gray and white matter changes and cognitive decline. Post mortem studies examining amyloid, tau, and other proteins will be discussed within the context of neurodegenerative diseases and chronic traumatic encephalopathy. The data support the suggestion that pathological changes triggered by an earlier TBI will have an influence on normal aging processes and will interact with neurodegenerative disease processes rather than the development of a specific disease, such as Alzheimer’s or Parkinson’s. Chronic neurophysiologic change after TBI may have detrimental effects on neurodegenerative disease.

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via The Impact of Traumatic Brain Injury on Later Life: Effects on Normal Aging and Neurodegenerative Diseases | Abstract

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[WEB SITE] First-ever neuroscience conference to explore ultra-personal approach to brain health

For three days this week, Roanoke, Virginia, is the capital of the precision neuroscience world.

The first-ever scientific meeting to explore an ultra-personal approach to brain health — the Virginia-Nordic Precision Neuroscience Conference — opened this week at the Virginia Tech Carilion Research Institute.

“The promise, hope, and opportunity for precision neuroscience is great — with the potential for realizing the brain and mind’s full potential, preventing disorders, and restoring brain health after injury or degenerative disease,” said Virginia Tech President Tim Sands, who welcomed about 200 scientists on behalf of Virginia Tech and Carilion Clinic. “It is also the responsibility of the scientific and medical communities to help define the real possibilities, differentiate hype from reality, and help focus the scientific enterprise and resource allocation on areas where the promise can be realized.”

More than 1,000 disorders of the brain and nervous system result in more hospitalizations than any other disease group, including heart disease and cancer.

“By understanding an individual’s genetics, behavior, education, habits, life experiences such as physical and psychological trauma — all the things that make people who they are — the neuroscientific community may be able to develop individually tailored plans for people to optimize education, health care, diet, exercise, and environments where they are likely to thrive cognitively, socially, and physically,” said Michael J. Friedlander, Virginia Tech’s vice president for health sciences and technology and the founding executive director of the Virginia Tech Carilion Research Institute.

The collaboration grew from an idea developed by Friedlander and Tor S. Haugstad, a neurologist and neuroscience chair at Sunnaas National Rehabilitation Hospital in Oslo, Norway, worked to develop as the Norway/U.S. Neuroscience Collaboration, initially called NUNC. The effort has grown to include multiple universities in Norway as well as in several other Nordic countries, and universities and foundations throughout Virginia.

People respond to brain injuries differently, which is one of the motivations for further development of the precision neuroscience field.

“We may get two people in our department with very similar brain injuries, and one may be rendered with a low level of consciousness while the other can recover and return home to his family and work life,” said Haugstad, who also chairs the traumatic brain rehabilitation program at Sunnaas National Rehabilitation Hospital. “We need to discover at cellular and molecular levels why people respond so differently, and tailor treatment and rehabilitation to the specific person.”

The meeting, which will continue through Friday, is the first to bring the top minds of precision neuroscience from across the globe together in a think-tank setting to explore the challenges and promise of bringing personalized medicine to brain health and brain disorders.

“One individual’s experience with Alzheimer’s disease, Parkinson’s disease, a traumatic brain injury, or various other neurological or psychiatric disorders will not be exactly like anyone else’s,” Friedlander said.

“From a business and health care point of view, clinical trials may fail because they target generic diseases that manifest very differently in different people,” Friedlander said. “If a drug or treatment doesn’t work in 75 percent of the people, it is considered a failure — but it worked in 25 percent. Should we forget about the 25 percent of people it helped and scrap potentially lifesaving therapies that may have cost hundreds of millions of dollars during a decade of development?”

By targeting groups of patients based on their predicted manifestations of a particular brain disorder, the success rate for finding new treatments will improve and the investment risk can be lessened, according to Friedlander.

“Essentially the pharmaceutical industry and investors de-risk their investments by having more precise, targeted therapies and tests that are more likely to be successful,” Friedlander said. “The treatment may be effective for 10 percent of people with a particular brain disease, but we can learn a lot about why those 10 percent may have benefitted based on their genetic composition and expression patterns and their life experiences. Then, we get back to work on a treatment for the next 10 percent, and the next 10 percent. It may not be one size fits all.”

Researchers will discuss innovations ranging from a Nobel prize-winning imaging system that visualizes the action of molecules within the brain, to the work of physician-scientists who are on the frontlines of health care delivery for brain injury, neurodegenerative diseases of aging, and brain developmental disorders.

In many ways, the conference has special meaning for the partner cities in Virginia and in Europe, Haugstad said.

“Roanoke is a city with a history of rail that, through innovation and spirit, is reinventing itself, and it is leading the way in precision neuroscience,” Haugstad said. “In Norway, a country that depends on oil revenue, the cities are changing much like cities in Virginia, by finding new ways to live and move forward. Together, we are very good partners.”

Source: Virginia Tech

Source: First-ever neuroscience conference to explore ultra-personal approach to brain health

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