Anita Goh

Tracking motor impairments in the progression of Huntington's disease

The Unified Huntingtons Disease Rating Scale is used to characterize motor impairments and establish motor diagnosis. Little is known about the timing of diagnostic confidence level categories and the trajectory of motor impairments during the prodromal phase. Goals of this study were to estimate the timing of categories, model the prodromal trajectory of motor impairments, estimate the rate of motor impairment change by category, and provide required sample size estimates for a test of efficacy in clinical trials. In total, 1010 gene‐expanded participants from the Neurobiological Predictors of Huntingtons Disease (PREDICT‐HD) trial were analyzed. Accelerated failure time models were used to predict the timing of categories. Linear mixed effects regression was used to model the longitudinal motor trajectories. Age and length of gene expansion were incorporated into all models. The timing of categories varied significantly by gene expansion, with faster progression associated with greater expansion. For the median expansion, the third diagnostic confidence level category was estimated to have a first occurrence 1.5 years before diagnosis, and the second and first categories were estimated to occur 6.75 years and 19.75 years before diagnosis, respectively. Motor impairments displayed a nonlinear prodromal course. The motor impairment rate of change increased as the diagnostic confidence level increased, with added acceleration for higher progression scores. Motor items can detect changes in motor impairments before diagnosis. Given a sufficiently high progression score, there is evidence that the diagnostic confidence level can be used for prodromal staging. Implications for Huntingtons disease research and the planning of clinical trials of efficacy are discussed.

Screening for depression and anxiety among older Chinese immigrants living in Western countries: The use of the Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI).

Depression and anxiety are two common mental health problems among older people. There is evidence that using well‐validated screening tools can improve detection of depression and anxiety among this group. The review explored the use of the Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI) for screening depression and anxiety among older Chinese immigrants, one of the largest and fastest growing groups of older immigrants in Western society. It focused on the GDS and GAI because both are designed specifically for older people.

Peduncular hallucinosis secondary to central pontine myelinolysis.

Peduncular hallucinations are generally associated with lesions in the midbrain. They have rarely been associated with central pontine myelinolysis, a condition associated with rapid alterations in serum sodium and chronic alcoholism. Described herein is the case of a 46‐year‐old man who developed typical peduncular hallucinations, whose imaging demonstrated central pontine myelinolysis. After alcohol cessation and neuroimaging resolution, the patients hallucinatory phenomena abated.

A retrospective study of medical comorbidities in psychogeriatric patients

This study contributes further research into the assessment and treatment of older psychiatric patients with medical comorbidities.

'Depression is not an illness. It's up to you to make yourself happy': Perceptions of Chinese health professionals and community workers about older Chinese immigrants' experiences of depression and anxiety.

The aim of this study was to improve our understanding of depression and anxiety among older immigrant Chinese Australians.

Pastoral care in old age psychiatry: Addressing the spiritual needs of inpatients in an acute aged mental health unit

Pastoral Care (PC) practitioners respond to the spiritual needs of patients and families of all spiritual orientations. The integrated PC service in an acute psychogeriatric inpatient ward at St Vincents Aged Mental Health Service, Melbourne, Australia, was examined to investigate how PC was being accessed by inpatients.

Huntington's disease research and practice: reflections on the journey made and lessons learned

Knowledge about some of the rarer causes of dementia is now quite advanced (Lautenschlager and Martins, 2005), which can in turn inform other more common causes of dementia. Such is the case with the monogenic disorder of Huntingtons disease (HD) when compared to, say, Alzheimers disease (AD). HD is an autosomal dominant hereditary neurodegenerative disease, which involves the basal ganglia, its connections to the frontal lobe and related neural circuits. The onset of HD is typically in mid-life (but onset can range from childhood to old age), with motor, cognitive and neuropsychiatric symptoms. There is currently no cure for this devastating and inevitably fatal neurodegenerative disease, with current treatment approaches being solely symptomatic. The highest frequencies of HD are found in Europe and in those countries whose populations are of predominately European origin such as the USA and Australia (approximately 1 case per 10,000 people).

A pilot study investigating the feasibility of symptom assessment manager (SAM), a Web-based real-time tool for monitoring challenging behaviors

Improving and minimizing challenging behaviors seen in psychiatric conditions, including behavioral and psychological symptoms of dementia are important in the care of people with these conditions. Yet there is a lack of systematic evaluation of these as a part of routine clinical care. The Neuropsychiatric Inventory is a validated and reliable tool for rating the severity and disruptiveness of challenging behaviors. We report on the evaluation of a Web‐based symptom assessment manager (SAM), designed to address the limitation of previous tools using some of the Neuropsychiatric Inventory functions, to monitor behaviors by staff caring for people with dementia and other psychiatric conditions in inpatient and residential care settings.

Predictors of Workplace Disability in a Premanifest Huntington’s Disease Cohort

Huntingtons disease (HD) is an inherited neurodegenerative disease involving motor, cognitive, and psychiatric/behavioral impairments that will eventually affect work role functioning. Few objective data exist regarding predictors of workplace disability in HD. The authors explored the predictors of work impairment and disability in a cross-sectional cohort of 656 employed, premanifest HD (preHD) individuals. In this cohort-the majority of whom were female, urban-dwelling, married/partnered, and working full-time, with minimal cognitive impairment, good function, minimal motor abnormality, and no indication of significant mental health issues-the number of participants who reported that they had missed work due to HD was low (2.4%). However, 12% of the study sample reported experiencing impairment while working due to preHD, 12.2% reported work-related activity impairment due to preHD, and 12.7% reported impairment in their overall work ability. Higher numbers of CAG repeats on the mutant allele and having more motor symptoms were associated with significantly higher odds of experiencing workplace impairment. Importantly, several modifiable factors were also found to predict workplace disability. Specifically, higher levels of anxiety symptoms were associated with significantly higher odds of experiencing workplace impairment. Good mental and physical health served as protective factors, where good physical health was associated with 6% lower odds of experiencing impairment or missing work time and good mental health was associated with of 10%-12% lower. The results provide important new knowledge for the development of future targeted intervention trials to support preHD individuals in maintaining their work roles as long as possible.

COGNITIVE TRAINING FOR OLDER ADULTS WITH DEMENTIA: AN UPDATED COCHRANE REVIEW

to compare training efficacy across methods, cognitive domains and populations. Methods: We performed four meta-analyses investigating the effects of CCT in healthy older adults, mild cognitive impairment (MCI), dementia and Parkinson’s disease. Analyses were performed for overall as well as domain-specific cognitive outcomes. A series of subgroup analyses and metaregression investigated heterogeneity across studies to examine the association between key design factors and effect sizes across populations, as well as within intervention and control groups. Results: Overall, 92 randomised controlled trials were included in the analyses. Overall efficacy was the greatest in MCI, driven by null effects within control groups. Control group effect sizes in other populations were small. Across all populations, effect sizes and their precision were comparable across active and passive-controlled studies. Supervised training and frequency not exceeding 3 times per week were associated with greater efficacy. Multidomain training was more efficacious on overall cognition than single-domain programs (e.g. working memory training). Combination of CCT with physical exercise was associated with greater effect sizes than CCT alone, but only when done simultaneously (e.g. exergaming) than consecutively. In contrast to moderate effect sizes on learning and memory, the effects on executive domains were small overall and mostly pronounced in trials of videogames and virtual reality. As expected, gains largely diminish after stopping training. Conclusions:The aggregate evidence makes a case for examining the long-term effectiveness of CCT on slowing cognitive decline, especially in MCI. Training appears to work best when based on combining drill-and-practice exercises with more novel approaches and targeting multiple domains simultaneously. Long-term head-to-head comparisons of combined intervention designs are key to guide clinical implementation in people at high dementia risk.