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Elgamal S.,University of Waterloo | Elgamal S.,Schlegel UW Research Institute for Aging | Denburg S.,McMaster University | Marriott M.,St. Josephs Healthcare | MacQueen G.,University of Calgary
Canadian Journal of Psychiatry | Year: 2010

Objectives: To compare the performance of depressed patients to healthy control subjects on discrete cognitive domains derived from factor analysis and to examine the factors that may influence the performance of depressed patients on cognitive domains in a large sample. Methods: We compared the cognitive performance of 149 patients with major depression to 104 healthy control subjects using multivariate ANCOVA. We used principal component factor analysis to group the cognitive variables into cognitive domains. Finally, we conducted regression analysis to examine the contribution of predictor factors to the cognitive domains that were impaired in the depressed group. Results: Verbal memory and speed of processing were impaired in depressed patients, compared with healthy control subjects. Patient IQ, duration of depressive illness, and number of hospitalizations significantly contributed to the performance of patients on verbal memory and speed of processing. The severity of mood symptoms did not correlate with performance on any cognitive domain. Conclusions: Understanding the factors that predict cognitive performance of patients with depression may provide an insight into the processes by which depression leads to cognitive dysfunction. Our study showed that premorbid IQ and factors related to burden of illness are strong independent predictors of cognitive dysfunction in patients with major depression. Source

Harkness K.,McMaster University | Harkness K.,Hamilton Health Sciences | Heckman G.A.,McMaster University | Heckman G.A.,Schlegel UW Research Institute for Aging | And 3 more authors.
Expert Review of Cardiovascular Therapy | Year: 2012

Managing older heart failure (HF) patients can be complicated by both cardiac and noncardiac conditions. Over the past 20 years, care for HF patients has become more complex, with a rising proportion of older people living with HF. In particular, cognitive impairment (CI) and frailty often coexist with HF in the elderly. With the prevalence of HF, frailty and cognitive impairment rising with age, the simultaneous occurrence of at least two of these conditions in the same individual will become more frequent. The presence of frailty and/or cognitive impairment in older people with HF is independently associated with worse clinical outcomes. The purpose of this review is to provide an overview of frailty and cognitive impairment in older HF patients. Specifically, this article describes the epidemiology of these conditions in HF patients, outlines potential underlying mechanisms, highlights relevant screening tools and reviews relevant clinical implications. © 2012 Expert Reviews Ltd. Source

Worden T.A.,University of Guelph | Vallis L.A.,University of Guelph | Vallis L.A.,Schlegel UW Research Institute for Aging
Journal of Motor Behavior | Year: 2014

The performance of 2 or more attention demanding tasks simultaneously is poorly understood. The purpose of the study was to investigate optimal practice strategies for performing 2 simultaneous tasks. Eighteen young adults walked and stepped over either a static or dynamic obstacle, while responding to an auditory Stroop test. Participants were randomly assigned to 1 of 3 groups: one that practiced both tasks simultaneously, practiced only the cognitive task, or received no practice. Results indicate that only the dual-task practice group showed significantly more improvement in the locomotor task through reduced variability of gait velocity, obstacle clearance, and takeoff distance. Findings demonstrate that the practice of two concurrent, attention demanding tasks results in the best performance improvement for both tasks. © 2014 Copyright © Taylor & Francis Group, LLC. Source

Worden T.A.,University of Guelph | De Jong A.F.,University of Guelph | Vallis L.A.,University of Guelph | Vallis L.A.,Schlegel UW Research Institute for Aging
Gait and Posture | Year: 2016

Navigating cluttered and complex environments increases the risk of falling. To decrease this risk, it is important to understand the influence of obstacle visual cues on stepping parameters, however the specific obstacle characteristics that have the greatest influence on avoidance strategies is still under debate. The purpose of the current work is to provide further insight on the relationship between obstacle appearance in the environment and modulation of stepping parameters. Healthy young adults (N= 8) first stepped over an obstacle with one visible top edge ("floating"; 8 trials) followed by trials where experimenters randomly altered the location of a ground reference object to one of 7 different positions (8 trials per location), which ranged from 6 cm in front of, directly under, or up to 6 cm behind the floating obstacle (at 2 cm intervals). Mean take-off and landing distance as well as minimum foot clearance values were unchanged across different positions of the ground reference object; a consistent stepping trajectory was observed for all experimental conditions. Contrary to our hypotheses, results of this study indicate that ground based visual cues are not essential for the planning of stepping and clearance strategies. The simultaneous presentation of both floating and ground based objects may have provided critical information that lead to the adoption of a consistent strategy for clearing the top edge of the obstacle. The invariant foot placement observed here may be an appropriate stepping strategy for young adults, however this may not be the case across the lifespan or in special populations. © 2015 Elsevier B.V. Source

Giangregorio L.M.,University of Waterloo | Giangregorio L.M.,A+ Network | Giangregorio L.M.,Schlegel UW Research Institute for Aging | Papaioannou A.,McMaster University | And 12 more authors.
Osteoporosis International | Year: 2014

A consensus process was conducted to develop exercise recommendations for individuals with osteoporosis or vertebral fractures. A multicomponent exercise program that includes balance and resistance training is recommended. Introduction: The aim was to develop consensus on exercise recommendations for older adults: (1) with osteoporosis and (2) with osteoporotic vertebral fracture(s). Methods: The Grading of Recommendations Assessment, Development, and Evaluation method was used to evaluate the quality of evidence and develop recommendations. Outcomes important for decision making were nominated by an expert panel and patient advocates. They included falls, fractures, bone mineral density (BMD), and adverse events for individuals with osteoporosis/vertebral fractures, and pain, quality of life, and function for those with vertebral fracture. Meta-analyses evaluating the effects of exercise on the outcomes were reviewed. Observational studies or clinical trials were reviewed when meta-analyses were not available. Quality ratings were generated, and informed the recommendations. Results: The outcome for which evidence is strongest is falls. Point estimates of the effects of exercise on falls, fractures, and BMD vary according to exercise type. There is not enough evidence to quantify the risks of exercise in those with osteoporosis or vertebral fracture. Few trials of exercise exist in those with vertebral fracture. The exercise recommendations for exercise in individuals with osteoporosis or osteoporotic vertebral fracture are conditional. The panel strongly recommends a multicomponent exercise program including resistance and balance training for individuals with osteoporosis or osteoporotic vertebral fracture. The panel recommends that older adults with osteoporosis or vertebral fracture do not engage in aerobic training to the exclusion of resistance or balance training. Conclusions: The consensus of our international panel is that exercise is recommended for older adults with osteoporosis or vertebral fracture, but our recommendations are conditional. © 2013 International Osteoporosis Foundation and National Osteoporosis Foundation. Source

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