Development and pilot testing of quality improvement indicators for integrated primary dementia care.

Background: Implementation of integrated primary care is considered an important strategy to overcome fragmentation and improve quality of dementia care. However, current quality indicator (QI) sets, to assess and improve quality of care, do not address the interprofessional context. The aim of this research was to construct a feasible and content-wise valid minimum dataset (MDS) to measure the quality of integrated primary dementia care.

The Object Space Task reveals increased expression of cumulative memory in a mouse model of Kleefstra syndrome.

Kleefstra syndrome is a disorder caused by a mutation in the EHMT1 gene characterized in humans by general developmental delay, mild to severe intellectual disability and autism. Here, we characterized cumulative memory in the Ehmt1 mouse model using the Object Space Task. We combined conventional behavioral analysis with automated analysis by deep-learning networks, a session-based computational learning model, and a trial-based classifier.

Epilepsy phenotype in individuals with chromosomal duplication encompassing .

Intragenic mutations in are associated with intractable seizures, developmental regression, intellectual disability, ataxia, hypotonia, and feeding difficulties. duplications are rarely reported, but it was suggested that those might have a similar gain-of-function effect and lead to a more or less comparable phenotype. A favorable response to the sodium blocker phenytoin was reported in several cases, both in patients with an intragenic mutation and in patients with a duplication of .

Impaired mitochondrial complex I function as a candidate driver in the biological stress response and a concomitant stress-induced brain metabolic reprogramming in male mice.

Mitochondria play a critical role in bioenergetics, enabling stress adaptation, and therefore, are central in biological stress responses and stress-related complex psychopathologies. To investigate the effect of mitochondrial dysfunction on the stress response and the impact on various biological domains linked to the pathobiology of depression, a novel mouse model was created. These mice harbor a gene trap in the first intron of the Ndufs4 gene (Ndufs4 mice), encoding the NDUFS4 protein, a structural component of complex I (CI), the first enzyme of the mitochondrial electron transport chain.

Orthostatic Blood Pressure Recovery Is Associated With the Rate of Cognitive Decline and Mortality in Clinical Alzheimer's Disease.

Background: Impaired recovery of blood pressure (BP) after standing has been shown to be related to cognitive function and mortality in people without dementia, but its role in people with Alzheimer's disease (AD) is unknown. The aim of this study was to investigate the association of the orthostatic BP response with cognitive decline and mortality in AD.

Methods: In this post hoc analysis of a randomized controlled trial (Nilvad), we measured the beat-to-beat response of BP upon active standing in mild-to-moderate AD.

Context and trade-offs characterize real-world threat detection systems: A review and comprehensive framework to improve research practice and resolve the translational crisis.

A better understanding of context in decision-making-that is, the internal and external conditions that modulate decisions-is required to help bridge the gap between natural behaviors that evolved by natural selection and more arbitrary laboratory models of anxiety and fear. Because anxiety and fear are mechanisms evolved to manage threats from predators and other exigencies, the large behavioral, ecological and evolutionary literature on predation risk is useful for re-framing experimental research on human anxiety-related disorders. We review the trade-offs that are commonly made during antipredator decision-making in wild animals along with the context under which the behavior is performed and measured, and highlight their relevance for focused laboratory models of fear and anxiety.

Anterior to Posterior Whole-Brain Gradient for Different Types of Memories?

Memories are consolidated from hippocampus to cortex, and recent evidence points to an anterior-posterior/ventral-dorsal gradient (in humans/rodents, respectively) across the brain that may be specialized for different types of memories. In a recent article, Cowan et al. provided evidence for this functional difference and gradient, which is also associated with sleep spindles.

Sjögren-Larsson syndrome: The mild end of the phenotypic spectrum.

Sjögren-Larsson syndrome (SLS) is a rare inborn error of lipid metabolism. The syndrome is caused by mutations in the gene, resulting in a deficiency of fatty aldehyde dehydrogenase. Most patients have a clearly recognizable severe phenotype, with congenital ichthyosis, intellectual disability, and spastic diplegia.

Ultrasound can differentiate inclusion body myositis from disease mimics.

Introduction: The diagnosis of inclusion body myositis (IBM) can be challenging, and its presentation can be confused with other forms of myositis or neuromuscular disorders. In this study we evaluate the ability of quantitative muscle ultrasound to differentiate between IBM and mimicking diseases.

Methods: Patients 50 years of age and older were included from two specialty centers.

A mechanistic model for individualised treatment of anxiety disorders based on predictive neural biomarkers.

Increased amygdala responsiveness is the hallmark of fear and a characteristic across patients with anxiety disorders. The amygdala is embedded in a complex regulatory circuit. Multiple different mechanisms may elevate amygdala responsiveness and lead to the occurrence of an anxiety disorder.

Urbanicity, biological stress system functioning and mental health in adolescents.

Growing up in an urban area has been associated with an increased chance of mental health problems in adults, but less is known about this association in adolescents. We examined whether current urbanicity was associated with mental health problems directly and indirectly via biological stress system functioning. Participants (n = 323) were adolescents from the Dutch general population.

Patient-Ventilator Interaction During Noninvasive Ventilation in Subjects With Exacerbation of COPD: Effect of Support Level and Ventilator Mode.

Background: Patient-ventilator synchrony in patients with COPD is at risk during noninvasive ventilation (NIV). NIV in neurally-adjusted ventilatory assist (NAVA) mode improves synchrony compared to pressure support ventilation (PSV). The current study investigated patient-ventilator interaction at 2 levels of NAVA and PSV mode in subjects with COPD exacerbation.

Recurrent interactions in local cortical circuits.

Most cortical synapses are local and excitatory. Local recurrent circuits could implement amplification, allowing pattern completion and other computations. Cortical circuits contain subnetworks that consist of neurons with similar receptive fields and increased connectivity relative to the network average.

Objectively-Measured Activity Patterns are Associated with Home Blood Pressure in Memory Clinic Patients.

Background: Physicians are cautious to prescribe antihypertensive drugs in frail older adults because of the potential adverse effects, especially in those with cognitive complaints. Lifestyle aspects might provide safe targets to lower blood pressure in older adults.

Objective: Our goal was to evaluate the associations between activity patterns and blood pressure in memory clinic patients.

Day-to-Day Home Blood Pressure Variability is Associated with Cerebral Small Vessel Disease Burden in a Memory Clinic Population.

Background: High visit-to-visit blood pressure variability (BPV) has been associated with cognitive decline and cerebral small vessel disease (cSVD), in particular cerebrovascular lesions. Whether day-to-day BPV also relates to cSVD has not been investigated.

Objective: To investigate the cross-sectional association between day-to-day BPV and total cSVD MRI burden in older memory clinic patients.

Sex Differences in Korsakoff's Syndrome for Inhibition but Not for Episodic Memory or Flexibility.

Background And Objectives: While sex differences in cognitive abilities have been extensively studied in healthy populations, little is known about these differences in patients with Korsakoff syndrome (KS).

Methods: We investigated sex differences in verbal episodic memory, inhibition, and flexibility in 25 patients with KS and 25 control participants.

Results: The analysis demonstrated no significant differences between women with KS and men with KS on episodic memory and flexibility, but higher inhibition was observed in women with KS compared with men with KS.

Surprise, value and control in anterior cingulate cortex during speeded decision-making.

Activity in the dorsal anterior cingulate cortex (dACC) is observed across a variety of contexts, and its function remains intensely debated in the field of cognitive neuroscience. While traditional views emphasize its role in inhibitory control (suppressing prepotent, incorrect actions), recent proposals suggest a more active role in motivated control (invigorating actions to obtain rewards). Lagging behind empirical findings, formal models of dACC function primarily focus on inhibitory control, highlighting surprise, choice difficulty and value of control as key computations.

The Effects of a TMS Double Perturbation to a Cortical Network.

Transcranial magnetic stimulation (TMS) is often used to understand the function of individual brain regions, but this ignores the fact that TMS may affect network-level rather than nodal-level processes. We examine the effects of a double perturbation to two frontoparietal network nodes, compared with the effects of single lesions to either node. We hypothesized that Bayesian evidence for the absence of effects that build upon one another indicates that a single perturbation is consequential to network-level processes.

Insulin Signaling as a Key Moderator in Myotonic Dystrophy Type 1.

Myotonic dystrophy type 1 (DM1) is an autosomal dominant genetic disease characterized by multi-system involvement. Affected organ system includes skeletal muscle, heart, gastro-intestinal system and the brain. In this review, we evaluate the evidence for alterations in insulin signaling and their relation to clinical DM1 features.

Haematoma evacuation in cerebellar intracerebral haemorrhage: systematic review.

Background: Guidelines regarding recommendations for surgical treatment of spontaneous cerebellar intracerebral haemorrhage (ICH) differ. We aimed to systematically review the literature to assess treatment strategies and outcomes.

Methods: We searched PubMed and Embase between 1970 and 2019 for randomised or otherwise controlled studies and observational cohort studies.

Value-based healthcare in ischemic stroke care: case-mix adjustment models for clinical and patient-reported outcomes.

Background: Patient-Reported Outcome Measures (PROMs) have been proposed for benchmarking health care quality across hospitals, which requires extensive case-mix adjustment. The current study's aim was to develop and compare case-mix models for mortality, a functional outcome, and a patient-reported outcome measure (PROM) in ischemic stroke care.

Methods: Data from ischemic stroke patients, admitted to four stroke centers in the Netherlands between 2014 and 2016 with available outcome information (N = 1022), was analyzed.

To what degree do patients actively choose their healthcare provider at the point of referral by their GP? A video observation study.

Background: Many countries in Europe have implemented managed competition and patient choice during the last decade. With the introduction of managed competition, health insurers also became an important stakeholder. They purchase services on behalf of their customers and are allowed to contract healthcare providers selectively.

The asynchronous state's relation to large-scale potentials in cortex.

Understanding the relation between large-scale potentials (M/EEG) and their underlying neural activity can improve the precision of research and clinical diagnosis. Recent insights into cortical dynamics highlighted a state of strongly reduced spike count correlations, termed the asynchronous state (AS). The AS has received considerable attention from experimenters and theorists alike, regarding its implications for cortical dynamics and coding of information.