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Hoang P.D.,University of New South Wales | Cameron M.H.,Oregon Health And Science University | Cameron M.H.,Portland Veteran Affairs Medical Center | Gandevia S.C.,University of New South Wales | Lord S.R.,University of New South Wales
Archives of Physical Medicine and Rehabilitation | Year: 2014

Objectives To determine whether impaired performance in a range of vision, proprioception, neuropsychological, balance, and mobility tests and pain and fatigue are associated with falls in people with multiple sclerosis (PwMS). Design Prospective cohort study with 6-month follow-up. Setting A multiple sclerosis (MS) physiotherapy clinic. Participants Community-dwelling people (N=210; age range, 21-74y) with MS (Disease Steps 0-5). Interventions Not applicable. Main Outcome Measures Incidence of falls during 6 months' follow-up. Results In the 6-month follow-up period, 83 participants (39.7%) experienced no falls, 57 (27.3%) fell once or twice, and 69 (33.0%) fell 3 or more times. Frequent falling (≥3) was associated with increased postural sway (eyes open and closed), poor leaning balance (as assessed with the coordinated stability task), slow choice stepping reaction time, reduced walking speed, reduced executive functioning (as assessed with the difference between Trail Making Test Part B and Trail Making Test Part A), reduced fine motor control (performance on the 9-Hole Peg Test [9-HPT]), and reported leg pain. Increased sway with the eyes closed, poor coordinated stability, and reduced performance in the 9-HPT were identified as variables that significantly and independently discriminated between frequent fallers and nonfrequent fallers (model χ2 3=30.1, P<.001). The area under the receiver operating characteristic curve for this model was.712 (95% confidence interval,.638-.785). Conclusions The study reveals important balance, coordination, and cognitive determinants of falls in PwMS. These should assist the development of effective strategies for prevention of falls in this high-risk group. © 2014 by the American Congress of Rehabilitation Medicine. Source

Dodge H.H.,Oregon Center for Aging and Technology | Dodge H.H.,Portland Veteran Affairs Medical Center | Mattek N.C.,Oregon Center for Aging and Technology | Mattek N.C.,Portland Veteran Affairs Medical Center | And 5 more authors.
Neurology | Year: 2012

Objective: To determine whether unobtrusive long-term in-home assessment of walking speed and its variability can distinguish those with mild cognitive impairment (MCI) from those with intact cognition. Methods: Walking speed was assessed using passive infrared sensors fixed in series on the ceiling of the homes of elderly individuals participating in the Intelligent Systems for Assessing Aging Change (ISAAC) cohort study. Latent trajectory models were used to analyze weekly mean speed and walking speed variability (coefficient of variation [COV]). Results: ISAAC participants living alone included 54 participants with intact cognition, 31 participants with nonamnestic MCI (naMCI), and 8 participants with amnestic MCI at baseline, with a mean follow-up of 2.6 ± 1.0 years. Trajectory models identified 3 distinct trajectories (fast, moderate, and slow) of mean weekly walking speed. Participants with naMCI were more likely to be in the slow speed group than in the fast (p = 0.01) or moderate (p = 0.04) speed groups. For COV, 4 distinct trajectories were identified: group 1, the highest baseline and increasing COV followed by a sharply declining COV; groups 2 and 3, relatively stable COV; and group 4, the lowest baseline and decreasing COV. Participants with naMCI were more likely to be members of either highest or lowest baseline COV groups (groups 1 or 4), possibly representing the trajectory of walking speed variability for early- and late-stage MCI, respectively. Conclusion: Walking speed and its daily variability may be an early marker of the development of MCI. These and other real-time measures of function may offer novel ways of detecting transition phases leading to dementia. Copyright © 2012 by AAN Enterprises, Inc. Source

Kimball T.A.,University of Colorado at Denver | Barz K.,Colorado Prevention Center | Dimond K.R.,University of Colorado at Denver | Edwards J.M.,Portland Veteran Affairs Medical Center | Nehler M.R.,University of Colorado at Denver
Journal of Vascular Surgery | Year: 2011

Background: The National Kidney Foundation-Kidney Diseases Outcomes Quality Initiative (KDOQI) for vascular access guidelines state that patients with late-stage chronic kidney disease (CKD) should undergo native arteriovenous fistula (AVF) creation at least 6 months before anticipated start of hemodialysis (HD) treatments to obviate the need for other vascular access types, such as grafts or central catheters. Objective: The objective of this study was to determine the incidence of HD, the functional patency, and associated morbidity of AVFs in patients with late-stage CKD placed according to KDOQI. Methods: Consecutive patients with late-stage CKD who underwent AVF creation using KDOQI guidelines for anatomy between January 2003 and December 2007 at two tertiary academic centers were retrospectively evaluated. Baseline demographics, AVF type, and clinical comorbidities were recorded. Patients were stratified into one of four groups (groups A-D) over the follow-up course based on two end points: patency of their AVF and whether or not they began HD. The ideal primary outcome was AVF maturation and use for HD (group A; cumulative functional patency). Other outcomes included AVF patency but no HD (group B), HD with AVF failure (group C), or no HD and AVF abandonment (ie, death, refused hemodialysis, kidney transplant, or fistula failure; group D). Secondary outcomes were time to first cannulation, complications, and secondary interventions. Results: AVFs were created (46% forearm and 54% upper arm) in 150 patients with CKD (85% men, median age 63 years old). At a median follow-up of 10 months, 74 patients (49%) were receiving HD and of these, 48 patients (65%) were using their AVF (group A), whereas 26 patients (35%) were not due to fistula failure (group C). Thirty-four patients (23%) never initiated HD treatments, but had a viable AVF (group B), and 42 patients (28%) never initiated HD and abandoned their AVF (group D). Overall, AVF abandonment was 51%. Mean maturation time of all AVFs successfully cannulated was 285 days (range, 30-1265 days). Complications encountered were maturation failure for cannulation (15%), focal stenosis requiring intervention (13%), inadequate flows on HD (9%), steal syndrome (9%), and thrombosis (8%). Cumulative functional patency for all AVFs was 19% and 27% at 6 and 12 months, respectively, with a mean number of two interventions per AVF (range, 1-10). Mortality during the study was 23%. Conclusion: Despite successful creation and maturation of a preemptive AVF in nearly two-thirds of patients who started HD during the follow-up and given the following observations: the high overall mortality of the population, the morbidity and costs in secondary procedures of AVF creation, and the high incidence of abandonment, it is unclear if this strategy would demonstrate a benefit in a randomized trial when compared to other access strategies. © 2011 Society for Vascular Surgery. Source

Thielke S.M.,University of Washington | Thielke S.M.,Geriatric Research | Mattek N.C.,Oregon Health And Science University | Hayes T.L.,Oregon Health And Science University | And 7 more authors.
Journal of the American Geriatrics Society | Year: 2014

Objectives To ascertain the association between self-report of low mood and unobtrusively measured behaviors (walking speed, time out of residence, frequency of room transitions, and computer use) in community-dwelling older adults using novel monitoring technologies. Design Longitudinal cohort study of older adults whose homes were outfitted with activity sensors. Participants completed Internet-based weekly health questionnaires with questions about mood. Setting Apartments and homes of older adults living in the Portland, Oregon, metropolitan area. Participants Adults, average age 84, followed for an average of 3.7 years (n = 157). Measurements Mood was assessed according to self-report each week. Walking speed, time spent out of residence, and room transitions were estimated using data from sensors; computer use was measured by timing actual use. The association between global or weekly low mood and the four behavior measures was ascertained, adjusting for baseline characteristics. Results Eighteen thousand nine hundred sixty weekly observations of mood were analyzed; 2.6% involved low mood. Individuals who reported low mood more often had no average differences in any behavior parameters from those who reported low mood less often. During weeks when they reported low mood, participants spent significantly less time out of residence and on the computer but showed no change in walking speed or room transitions. Conclusion Low mood in these community-dwelling older adults involved going out of the house less and using the computer less but no consistent changes in movements. Technologies to monitor in-home behavior may have potential for research and clinical care. © Published 2014. This article is a U.S. Government work and is in the public domain in the U.S.A. Source

Dodge H.H.,Oregon Health And Science University | Dodge H.H.,University of Michigan | Mattek N.,Oregon Health And Science University | Gregor M.,Oregon Health And Science University | And 6 more authors.
Current Alzheimer Research | Year: 2015

Background: Detecting early signs of Alzheimer’s disease (AD) and mild cognitive impairment (MCI) during the pre-symptomatic phase is becoming increasingly important for costeffective clinical trials and also for deriving maximum benefit from currently available treatment strategies. However, distinguishing early signs of MCI from normal cognitive aging is difficult. Biomarkers have been extensively examined as early indicators of the pathological process for AD, but assessing these biomarkers is expensive and challenging to apply widely among pre-symptomatic community dwelling older adults. Here we propose assessment of social markers, which could provide an alternative or complementary and ecologically valid strategy for identifying the pre-symptomatic phase leading to MCI and AD. Methods: The data came from a larger randomized controlled clinical trial (RCT), where we examined whether daily conversational interactions using remote video telecommunications software could improve cognitive functions of older adult participants. We assessed the proportion of words generated by participants out of total words produced by both participants and staff interviewers using transcribed conversations during the intervention trial as an indicator of how two people (participants and interviewers) interact with each other in one-on-one conversations. We examined whether the proportion differed between those with intact cognition and MCI, using first, generalized estimating equations with the proportion as outcome, and second, logistic regression models with cognitive status as outcome in order to estimate the area under ROC curve (ROC AUC). Results: Compared to those with normal cognitive function, MCI participants generated a greater proportion of words out of the total number of words during the timed conversation sessions (p=0.01). This difference remained after controlling for participant age, gender, interviewer and time of assessment (p=0.03). The logistic regression models showed the ROC AUC of identifying MCI (vs. normals) was 0.71 (95% Confidence Interval: 0.54 – 0.89) when average proportion of word counts spoken by subjects was included univariately into the model. Conclusion: An ecologically valid social marker such as the proportion of spoken words produced during spontaneous conversations may be sensitive to transitions from normal cognition to MCI. © 2015 Bentham Science Publishers. Source

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