Christopher M. Nguyen

Cognitive features 10 or more years after successful breast cancer survival: comparisons across types of cancer interventions

The present study examined the long‐term cognitive implications of cancer treatment among breast cancer survivors aged 65 years and older to better understand the long term implications of cancer treatment.

Effects of Age, Sex, and Neuropsychological Performance on Financial Decision-Making

The capacity to make sound financial decisions across the lifespan is critical for interpersonal, occupational, and psychological health and success. In the present study, we explored how healthy younger and older adults make a series of increasingly complex financial decisions. One-hundred sixteen healthy older adults, aged 56–90 years, and 102 college undergraduates, completed the Financial Decision-Making Questionnaire, which requires selecting and justifying financial choices across four hypothetical scenarios and answering questions pertaining to financial knowledge. Results indicated that Older participants significantly outperformed Younger participants on a multiple-choice test of acquired financial knowledge. However, after controlling for such pre-existing knowledge, several age effects were observed. For example, Older participants were more likely to make immediate investment decisions, whereas Younger participants exhibited a preference for delaying decision-making pending additional information. Older participants also rated themselves as more concerned with avoiding monetary loss (i.e., a prevention orientation), whereas Younger participants reported greater interest in financial gain (i.e., a promotion orientation). In terms of sex differences, Older Males were more likely to pay credit card bills and utilize savings accounts than were Older Females. Multiple positive correlations were observed between Older participants’ financial decision-making ability and performance on neuropsychological measures of non-verbal intellect and executive functioning. Lastly, the ability to justify one’s financial decisions declined with age, among the Older participants. Several of the aforementioned results parallel findings from the medical decision-making literature, suggesting that older adults make decisions in a manner that conserves diminishing cognitive resources.

Trustworthiness and Negative Affect Predict Economic Decision-Making

The Ultimatum Game (UG) is a widely used and well-studied laboratory model of economic decision making. Here, we studied 129 healthy adults and compared demographic (i.e., age, gender, education), cognitive (i.e., intelligence, attention/working memory, speed, language, visuospatial, memory, executive functions), and personality (i.e., “Big Five”, positive affect, negative affect) variables between those with a “rational” versus an “irrational” response pattern on the UG. Our data indicated that participants with “rational” UG performance (accepting any offer, no matter the fairness) endorsed higher levels of trust, or the belief in the sincerity and good intentions of others, whereas participants with “irrational” UG performance (rejecting unfair offers) endorsed higher levels of negative affect, such as anger and contempt. These personality variables were the only ones that differentiated the two response patterns—demographic and cognitive factors did not differ between rational and irrational players. The results indicate that the examination of personality and affect is crucial to our understanding of the individual differences that underlie decision making.

Decision-making deficits in normal elderly persons associated with executive personality disturbances.

BACKGROUND The problems that some community-dwelling elderly persons develop in real-world decision-making may have disastrous consequences for their health and financial well-being. Investigations across the adult life span have identified personality as an important individual differences variable that is related to decision-making ability. The aim of this study was to investigate the relationship between personality characteristics, as rated by an informant, and complex decision-making performance among elderly persons. It was hypothesized that deficits in decision-making would be associated with personality characteristics reflecting weak executive functioning (Lack of Planning, Poor Judgment, Lack of Persistence, Perseveration, Lack of Initiative, Impulsivity, and Indecisiveness). METHODS Fifty-eight elderly persons participated. Their health and cognitive status were deemed intact via comprehensive neuropsychological evaluation. The Iowa Scales of Personality, completed by an informant, was used to assess personality characteristics, and the Iowa Gambling Task, completed by the participant, was used to assess complex decision-making abilities. RESULTS Longstanding disturbances in executive personality characteristics were found to be associated with poor decision-making, and these disturbances remained predictive of poor decision-making even after taking into consideration demographic, neuropsychological, and mood factors. Acquired personality disturbances did not add significantly to prediction after longstanding disturbances were taken into account. Disturbances in other dimensions of personality were not significantly associated with poor decision-making. CONCLUSIONS Our study suggests that attentiveness to the personality correlates of difficulties with aspects of executive functioning over the adult years could enhance the ability to identify older individuals at risk for problems with real-world decision-making.

Neuropsychological Performance, Brain Imaging, and Driving Violations in Multiple Sclerosis

OBJECTIVE To examine the relationship between third ventricular width, a measure of thalamic brain atrophy, and motor vehicle violation type and frequency in a cohort of patients with multiple sclerosis (MS). DESIGN Retrospective cohort study. SETTING Tertiary care university hospital. PARTICIPANTS Thirty-five individuals with clinically confirmed relapsing-remitting multiple sclerosis and 35 age-, sex-, and education-matched community-dwelling healthy comparisons (N=70). Participants were aged between 25 and 65 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Data on motor vehicle violations were obtained from an online database (Iowa Courts Online). The violations were categorized as follows: (1) speeding, (2) nonmoving safety, (3) administrative, (4) alcohol-related offense, (5) moving safety, and (6) total violations. Neuropsychological performance in all major cognitive domains was obtained. Thalamic atrophy for the patients with MS was determined via third ventricular width measurement. RESULTS The MS group had a greater number of overall violations, administrative violations, and nonmoving safety violations. The groups differed on neuropsychological tasks measuring visuospatial skills, speeded language, learning, and executive functioning, after controlling for affective symptoms. Third ventricular width was associated with total violations as well as moving safety violations. Finally, third ventricular width accounted for a significant variance in driving violation frequency above and beyond demographic variables and neuropsychological factors. CONCLUSIONS There is an increased frequency of motor vehicle violations among patients with multiple sclerosis, and the number of violations can be predicted by thalamic brain atrophy.

A cross-national cross-sectional survey of the attitudes and perceived competence of final-year medicine, nursing and pharmacy students in relation to end-of-life care in dementia

Background: Little is known about the attitudes of healthcare professional students’ perceived competence and confidence in treating those with dementia who are at the end of life. Aim: To explore the attitudes of final year medical, nursing and pharmacy students towards people with dementia and to evaluate their perceived competence and confidence dealing with biomedical and psychosocial issues within the context of palliative care provision to patients with dementia. Design: Cross-sectional survey using a questionnaire. Setting/participants: Final-year students in each profession from Queen’s University Belfast (Northern Ireland) and the University of Iowa (USA) were recruited. Method: Three versions of an online questionnaire (containing the Attitudes to Dementia Questionnaire and a series of questions on end-of-life care in dementia) were distributed. Results: A total of 368 responses were received (response rate 42.3%). All respondents reported positive attitudes towards people with dementia. US nursing students reported significantly more positive attitudes than the medical students of United States and Northern Ireland. Medical students were more likely to report low confidence in discussing non-medical aspects of dying, whereas nursing students were most likely to feel prepared and confident to do this. Medical and nursing students reported low confidence with aspects of medication-related care; however, data from the pharmacy samples of Northern Ireland and United States suggested that these students felt confident in advising other healthcare professionals on medication-related issues. Conclusions: While healthcare students hold positive attitudes towards people with dementia, some clinical tasks remain challenging and further basic training may be of benefit.

Perceptions of masculinity and fatherhood among men experiencing homelessness.

This study explored the perceptions of fatherhood held by 11 men living in a homeless shelter. Using consensual qualitative research methodology (CQR; Hill, 2012), we investigated perceptions of masculinity and fatherhood among fathers experiencing homelessness. Participants described (a) their perceptions of masculinity and fatherhood and changes resulting from homelessness, (b) physical and psychological challenges of being a father experiencing homelessness, and (c) expectations of homeless fathers. The fathers generally expressed feelings of low self-esteem related to their perceived difficulty fulfilling the role of providers for their family; however, they also adapted their view of fatherhood to include roles suited to their situation, such as that of guide, teacher, and role model. Suggestions are made for clinicians in helping fathers navigate and develop these roles, and limitations and directions for future research are discussed.

The Use of Problem-Solving Therapy for Primary Care to Enhance Complex Decision-Making in Healthy Community-Dwelling Older Adults

Some older adults who are cognitively healthy have been found to make poor decisions. The vulnerability of such older adults has been postulated to be the result of disproportionate aging of the frontal lobes that contributes to a decline in executive functioning abilities among some older adults. The purpose of this study was to investigate whether decision-making performance in older adults can be enhanced by a psychoeducational intervention. Twenty cognitively and emotionally intact persons aged 65 years and older were recruited and randomized into two conditions: psychoeducational condition [Problem-Solving Therapy for Primary Care (PST-PC)] and no-treatment Control group. Participants in the psychoeducational condition each received four 45-min sessions of PST-PC across a 2-week period. The Iowa Gambling Task (IGT) was administered as the outcome measure to the treatment group, while participants in the Control group completed the IGT without intervention. A significant interaction effect was observed between group status and the trajectory of score differences across trials on the IGT. Particularly, as the task progressed to the last 20% of trials, participants in the PST-PC group significantly outperformed participants in the Control group in terms of making more advantageous decisions. These findings demonstrated that a four-session problem-solving therapy can reinforce aspects of executive functioning (that may have declined as a part of healthy aging), thereby enhancing complex decision-making in healthy older adults.

Feasibility of prophylactic haloperidol to prevent delirium in cancer patients.

232 Background: Approximately 2.5 million cancer patients are hospitalized annually and 25-40% of them will suffer from delirium; yet the majority of delirium is not diagnosed or treated. Delirium rates vary by age and reason for hospitalization and can be as high as 70% in hematopoietic stem cell transplant (HSCT) patients post-transplantation. Delirium can have devastating short and long-term complications and research is ongoing to see if it can be prevented. This study aims to: 1) demonstrate the feasibility of using prophylactic haloperidol in HSCT patients; 2) determine the side effects of oral haloperidol in HSCT patients; and 3) explore the hypothesis that prophylactic haloperidol will reduce the rate of delirium following HCST. METHODS All cognitively intact HSCT patients at a large academic institution were approached for study inclusion. Patients with delirium at time of screening or antipsychotic use in the previous 30 days were excluded. All participants received 5 mg oral haloperidol the night prior to transplant and nightly for 2 weeks post-transplant. Participants were seen daily to evaluate for side effects and every other day to evaluate for delirium using the Delirium Rating Scale (DRS-98). RESULTS Of the 19 patients who enrolled: 5 withdrew; 9 completed the full (2 week) study; and 5 completed a portion of the study. 22% (2 of 9) patients developed delirium (compared to a historical rate of 43% on our unit). Haloperidol was well tolerated with no evidence of major side effects (1 report of mild restlessness and 1 patient had transient evidence of sedation). CONCLUSIONS Oral haloperidol was well tolerated in HSCT patients. While this study was not designed to detect differences in delirium incidence it provides promising evidence that prophylactic haloperidol may decrease delirium post-HSCT.