April Au

Is immune system‐related hypertension associated with ovarian hormone deficiency?

What is the topic of this review? This review summarizes recent data on the role of ovarian hormones and sex in inflammation‐related hypertension. What advances does it highlight? The adaptive immune system has recently been implicated in the development of hypertension in males but not in females. The role of the immune system in the development of hypertension in women and its relationship to ovarian hormone production are highlighted.

‘Accepting where I'm at’ – a qualitative study of the mechanisms, benefits, and impact of a behavioral memory intervention for community-dwelling older adults

ABSTRACT Objective: Gain novel, in-depth insight into therapeutic mechanisms, benefits, and impact of a multi-modal behavioral memory intervention for older adults with concerns about memory. Methods: Participants were11 community-dwelling older adults (aged 63–88) who completed the Memory and Aging Program, an evidence-based multi-modal group intervention for normal age-related memory change. Semi-structured interviews were administered post-intervention. Responses were analyzed using qualitative content analysis until meaningful themes were agreed upon. Results: Analyses revealed a main theme of normalization as the overarching benefit of participation. The mechanism for this comprised both specific intervention content and the process of participating with others. A positive impact of the intervention was demonstrated at emotional (feelings of reassurance, hope, and confidence) and functional (increasing motivation for lifestyle change) levels; for some, there was a direct link between emotion and function. Conclusion: This study highlighted a single, prominent therapeutic benefit of normalization, illustrated a dual mechanism for achieving this, and characterized a nuanced inter-relationship of the emotional and functional impact of the intervention for participants. Results support the notion that group behavioral interventions can educate, empower, and promote psychological well-being in older adults and may be an effective avenue to reduce risk of disease and promote sustained functional independence.

Comparable achievement of client-identified, self-rated goals in intervention and no-intervention groups: reevaluating the use of Goal Attainment Scaling as an outcome measure

ABSTRACT Goal Attainment Scaling (GAS) is widely used as a measure of client-centered outcomes in clinical interventions. There are few well-controlled studies using GAS, however, and this limits the conclusions that can be drawn about the determinants of goal attainment post-intervention. In collaboration with researchers, 67- community-dwelling older adults used GAS to establish individualised goals for lifestyle change and memory strategy use in a randomised controlled trial of a multidimensional memory program (ClinicalTrials.gov: NCT02087137). Participants were allocated to an intervention or no-contact control group. Goal attainment was self-rated by participants at baseline, immediate post-intervention, and six-week follow-up. A mixed-model analysis of variance revealed a main effect of time, but no main effect of group and no interaction between time and group. In both the intervention and control groups, respectively, T-scores increased from baseline (Ms = 37 and 37) to post-intervention (Ms = 52 and 50) and were stable at follow-up (Ms = 52 and 51). Results were similar using ordinal data interpretation. Comparable goal attainment in participants receiving intervention versus no intervention underscores the importance of control groups in evaluation studies utilising GAS as an outcome measure, and supports a possible therapeutic contribution of setting and rating goals with GAS.

Psychometric properties of the Actual Week test: a naturalistic prospective memory task

Abstract Objective: Prospective memory is the ability to ‘remember to remember’ and a facet of memory important to everyday functioning. For older adults, prospective memory slips are a common concern. In the present study, we conducted an initial validation of a paper-and-pencil adaptation of the Actual Week test, and reported on internal consistency, inter-rater and test-retest reliability, convergent and divergent validity, as well as veridicality of the task. Method: Fifty-eight healthy, community-dwelling older adults were recruited from a larger randomized controlled trial and tested at baseline. The Actual Week test was a naturalistic five-day prospective memory task where participants were assigned eight hypothetical tasks to remember per day for five days. Tasks were either time-cued or event-cued and regular (i.e. occurring daily) or irregular (i.e. varied each day). The proportion of tasks that were recorded as on time and accurate was used as the primary measure of performance. Results: The Actual Week test had good internal consistency (Kuder–Richardson: r > .8), intra-test (intraclass correlation: α > .9) and test-retest reliability (r = .76). There was also evidence for convergent and divergent validity. Task performance was associated with age, but not years of education or sex. Conclusion: The Actual Week test demonstrated strong psychometric qualities and promising evidence for validity as a performance-based measure of everyday prospective memory in older adults. Avenues for future studies include extending the evidence for convergent validity and evaluating feasibility and utility with other clinical populations.

Cognitive changes following oophorectomy

Background: Epidemiological evidence indicating oophorectomy prior to natural menopause is associated with an increased risk of Alzheimer’s Disease (Rocca et al., 2007) and parkinsonism (Rocca et al., 2008) suggests that estrogen deprivation is implicated in cognitive decline. However, the trajectory of cognitive changes following oophorectomy is poorly understood beyond six months post-surgically (Sherwin, 1988). The purpose of this study was to determine the long-term effects of estrogen deprivation induced by oophorectomy on cognitive functioning, up to ten years post-surgically. Methods: The experimental group comprised of female carriers of the BRCA1/2 mutation who had undergone a bilateral salpingo-oophorectomy (BSO; removal of fallopian tubes and ovaries) between one to seven years ago as prophylaxis against the risk of gynaecological cancers. An agematched control group of healthy women and a BRCA control group comprised of women with a BRCA mutation prior to oophorectomy were also recruited. All women were tested once a year, for three years using a battery of neuropsychological tests assessing spatial and verbal memory, working memory, as well as executive functioning. Urine and saliva samples were taken respectively to determine estrogen levels at the time of testing and apolipoprotein E (APOE) genotype. It was hypothesized that women who have undergone BSO would score lower on measures of verbal memory. Carriers of the APOE E4 allele who had undergone BSO were hypothesized to perform the worst as the E4 allele is associated with an increased vulnerability to Alzheimer’s disease. Results: Results indicate that women with BSO performed significantly worse than age-matched controls on the immediate and delayed recall of the Logical Memory task of the Wechsler Memory Scale. Years since oophorectomy was also negatively correlated to the score on the delayed recall of the RAVLTafter controlling for age. Conclusions: Preliminary results suggest that premature estrogen deprivation is associated with a decrement in verbal memory compared to women matched in age and education. Importantly, time since BSO appears to exacerbate the decline of verbal memory independent of age. Results corroborate previous research showing cognitive decline post-BSO, but also suggests that verbal memory declines as a function of time since estrogen deprivation.