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Objective: The objective of this study was to systematically review all literature studying the effect of patient education on patient engagement through patient portals. Introduction: Patient portals provide patients access to health records, lab results, medication refills, educational materials, secure messaging, appointment scheduling, and telehealth visits, allowing patients to take a more active role in their health care decisions and management. A debate remains around whether these additional aids actually improve patient engagement and increase their ability to manage their own health conditions. This systematic review looks specifically at the effect of educational materials included in patient portals. Materials and Methods: In accordance with PRISMA guidelines, the literature search was mapped across 5 databases (PubMed, CINAHL, Scopus, PsychINFO, Embase), and implemented on June 2, 2020. Results: Fifty-two studies were included in the review. Forty-six (88.5%) reported rates of patient utilization of educational resources in the patient portal. Thirty (57.9%) shared patients' perceptions of the usefulness of the education materials. Twenty-one (40.4%) reported changes in health outcomes following educational interventions through the patient portal. This review found that efforts are indeed being made to raise awareness of educational resources in patient portals, that patients are increasingly utilizing these resources, that patients are finding them useful, and that they are improving health outcomes. Conclusion: It seems that patient portals are becoming a powerful tool for patient education and engagement, and show promise as a means of achieving the quadruple aim of healthcare. Moving forward, research should establish more uniform methods of measurement in order to strengthen the literature surrounding the effectiveness of patient education through patient portals.
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BACKGROUND/OBJECTIVES: Brief cognitive screens lack the sensitivity to detect mild cognitive impairment (MCI) or support differential diagnoses. The objective of this study was to validate the 10-minute, tablet-based University of California, San Francisco (UCSF) Brain Health Assessment (BHA) to overcome these limitations. DESIGN: Cross-sectional. SETTING: UCSF Memory and Aging Center. PARTICIPANTS: Older adults (N = 347) (neurologically healthy controls (n = 185), and individuals diagnosed with MCI (n = 99), dementia (n = 42), and as normal with concerns (n = 21)). MEASUREMENTS: The BHA includes subtests of memory, executive function and speed, visuospatial skills, and language and an optional informant survey. Participants completed the Montreal Cognitive Assessment (MoCA) and criterion-standard neuropsychological tests. Standardized structural 3T brain magnetic resonance imaging was performed in 145 participants. RESULTS: At a fixed 85% specificity rate, the BHA had 100% sensitivity to dementia and 84% to MCI; the MoCA had 75% sensitivity to dementia and 25% to MCI. The BHA had 83% sensitivity to MCI likely due to AD and 88% to MCI unlikely due to AD, and the MoCA had 58% sensitivity to MCI likely AD and 24% to MCI unlikely AD. The BHA subtests demonstrated moderate to high correlations with the criterion-standard tests from their respective cognitive domains. Memory test performance correlated with medial temporal lobe volumes; executive and speed with frontal, parietal, and basal ganglia volumes; and visuospatial with right parietal volumes. CONCLUSION: The BHA had excellent combined sensitivity and specificity to detect dementia and MCI, including MCI due to diverse etiologies. The subtests provide efficient, valid measures of neurocognition that are critical in making a differential diagnosis.
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Encéfalo , Tamizaje Masivo , Trastornos Neurocognitivos/diagnóstico , Pruebas Neuropsicológicas/estadística & datos numéricos , Anciano , Estudios Transversales , Humanos , Imagen por Resonancia Magnética , San Francisco , Sensibilidad y Especificidad , Encuestas y CuestionariosRESUMEN
Our brains represent spatial information in egocentric (self-based) or allocentric (landmark-based) coordinates. Rodent studies have demonstrated a critical role for the caudate in egocentric navigation and the hippocampus in allocentric navigation. We administered tests of egocentric and allocentric working memory to individuals with premotor Huntington's disease (pmHD), which is associated with early caudate nucleus atrophy, and controls. Each test had 80 trials during which subjects were asked to remember 2 locations over 1-sec delays. The only difference between these otherwise identical tests was that locations could only be coded in self-based or landmark-based coordinates. We applied a multiatlas-based segmentation algorithm and computed point-wise Jacobian determinants to measure regional variations in caudate and hippocampal volumes from 3T MRI. As predicted, the pmHD patients were significantly more impaired on egocentric working memory. Only egocentric accuracy correlated with caudate volumes, specifically the dorsolateral caudate head, right more than left, a region that receives dense efferents from dorsolateral prefrontal cortex. In contrast, only allocentric accuracy correlated with hippocampal volumes, specifically intermediate and posterior regions that connect strongly with parahippocampal and posterior parietal cortices. These results indicate that the distinction between egocentric and allocentric navigation applies to working memory. The dorsolateral caudate is important for egocentric working memory, which can explain the disproportionate impairment in pmHD. Allocentric working memory, in contrast, relies on the hippocampus and is relatively spared in pmHD.
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Núcleo Caudado/diagnóstico por imagen , Hipocampo/diagnóstico por imagen , Enfermedad de Huntington/psicología , Memoria a Corto Plazo , Autoimagen , Percepción Social , Adulto , Algoritmos , Análisis de Varianza , Femenino , Humanos , Enfermedad de Huntington/diagnóstico por imagen , Imagenología Tridimensional , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Tamaño de los Órganos , Memoria Espacial , Percepción VisualRESUMEN
Analogous behavioral assays are needed across animal models and human patients to improve translational research. Here, we examined the extent to which performance in the Morris water maze - the most frequently used behavioral assay of spatial learning and memory in rodents - translates to humans. We designed a virtual version of the assay for human subjects that includes the visible-target training, hidden-target learning, and probe trials that are typically administered in the mouse version. We compared transgenic mice that express human amyloid precursor protein (hAPP) and patients with mild cognitive impairment due to Alzheimer's disease (MCI-AD) to evaluate the sensitivity of performance measures in detecting deficits. Patients performed normally during visible-target training, while hAPP mice showed procedural learning deficits. In hidden-target learning and probe trials, hAPP mice and MCI-AD patients showed similar deficits in learning and remembering the target location. In addition, we have provided recommendations for selecting performance measures and sample sizes to make these assays sensitive to learning and memory deficits in humans with MCI-AD and in mouse models. Together, our results demonstrate that with careful study design and analysis, the Morris maze is a sensitive assay for detecting AD-relevant impairments across species.
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Enfermedad de Alzheimer/fisiopatología , Aprendizaje por Laberinto , Memoria , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/genética , Enfermedad de Alzheimer/metabolismo , Enfermedad de Alzheimer/patología , Precursor de Proteína beta-Amiloide/biosíntesis , Precursor de Proteína beta-Amiloide/genética , Animales , Femenino , Humanos , Masculino , Ratones , Ratones Transgénicos , Especificidad de la EspecieRESUMEN
BACKGROUND: We examined the sensitivity of different executive function measures for detecting deficits in Parkinson's disease patients without dementia. METHODS: Twenty-one non-demented PD subjects and 21 neurologically healthy controls were administered widely used clinical executive functioning measures as well as the NIH EXAMINER battery, which produces Cognitive Control, Working Memory, and Verbal Fluency scores, along with an overall Executive Composite score, using psychometrically matched scales. RESULTS: No significant differences between groups were observed on widely used clinical measures. The PD patients scored lower than controls on the EXAMINER Executive Composite, Cognitive Control, and Working Memory Scores. CONCLUSIONS: The NIH EXAMINER Executive Composite and Cognitive Control Scores are sensitive measures of executive dysfunction in non-demented PD, and may be more sensitive than several widely used measures. Results highlight the importance of careful test selection when evaluating for mild cognitive impairment in PD.
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Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Función Ejecutiva/fisiología , Pruebas Neuropsicológicas , Enfermedad de Parkinson/complicaciones , Anciano , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Memoria a Corto Plazo/fisiología , Persona de Mediana Edad , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Conducta Verbal/fisiologíaRESUMEN
BACKGROUND: We investigated the viability of psychometrically robust executive function measures as markers for premanifest Huntington's disease (HD). METHODS: Fifteen premanifest HD subjects and 42 controls were compared on the NIH EXAMINER executive function battery. This battery yields an overall executive composite score, plus working memory, cognitive control, and fluency scores that are measured on psychometrically matched scales. The scores were correlated with two disease markers, disease burden and striatal volumes, in the premanifest HD subjects. RESULTS: The premanifest HD subjects scored significantly lower on the working memory score. The executive composite positively correlated with striatal volumes, and the working memory score negatively correlated with disease burden. The cognitive control and fluency scores did not differ between the groups or correlate significantly with the disease markers. CONCLUSIONS: The NIH EXAMINER executive composite and working memory scores are sensitive markers of cognitive dysfunction, striatal volume, and disease burden in premanifest HD.
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Trastornos del Conocimiento/fisiopatología , Función Ejecutiva/fisiología , Enfermedad de Huntington/fisiopatología , Memoria a Corto Plazo/fisiología , Adulto , Anciano , Trastornos del Conocimiento/psicología , Femenino , Humanos , Enfermedad de Huntington/psicología , Masculino , Persona de Mediana Edad , Pruebas NeuropsicológicasRESUMEN
The objective of this study was to investigate how acetylcholinesterase inhibitor (ChEI) treatment affects brain function in Parkinson's disease (PD). Twelve patients with PD and either dementia or mild cognitive impairment underwent task-free functional magnetic resonance imaging before and after 3 months of ChEI treatment and were compared with 15 age- and sex-matched neurologically healthy controls. Regional spontaneous brain activity was measured using the fractional amplitude of low-frequency fluctuations. At baseline, patients showed reduced spontaneous brain activity in regions important for motor control (eg, caudate, supplementary motor area, precentral gyrus, thalamus), attention and executive functions (eg, lateral prefrontal cortex), and episodic memory (eg, precuneus, angular gyrus, hippocampus). After treatment, the patients showed a similar but less extensive pattern of reduced spontaneous brain activity relative to controls. Spontaneous brain activity deficits in the left premotor cortex, inferior frontal gyrus, and supplementary motor area were restored such that the activity was increased posttreatment compared with baseline and was no longer different from controls. Treatment-related increases in left premotor and inferior frontal cortex spontaneous brain activity correlated with parallel reaction time improvement on a test of controlled attention. PD patients with cognitive impairment show numerous regions of decreased spontaneous brain function compared with controls, and rivastigmine is associated with performance-related normalization in the left frontal cortex function.