Hope Center Member Publications

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Adverse driving behaviors are associated with sleep apnea severity and age in cognitively normal older adults at risk for Alzheimer’s disease(2022) Sleep, 45 (6), . 

Doherty, J.M.a , Roe, C.M.a , Murphy, S.A.a , Johnson, A.M.b , Fleischer, E.c , Toedebusch, C.D.a , Redrick, T.a , Freund, D.a , Morris, J.C.a d e , Schindler, S.E.a e , Fagan, A.M.a d e , Holtzman, D.M.a d e f , Lucey, B.P.a d f , Babulal, G.M.a g h i

AbstractAlzheimer’s disease (AD) pathology accumulates for decades before the onset of cognitive decline. Cognitively normal individuals with biomarker evidence of AD brain pathology (i.e. biomarker + or preclinical AD) can be differentiated from individuals without AD brain pathology based on naturalistic driving data, such as hard acceleration or braking and speeding, measured using in-vehicle dataloggers. Older adults are at increased risk of injury and death from motor vehicle crashes and driving cessation is also linked to negative health outcomes. Identifying potentially modifiable risk factors that increase driving risk may prolong safe driving in old age. Sleep apnea is associated with adverse driving behaviors across the age span. In this study, we hypothesized that high-risk driving behaviors would be associated with increased sleep apnea severity and AD pathology. We found that higher sleep apnea severity measured by a home sleep apnea test was associated with a higher incidence of adverse driving behaviors even after controlling for multiple confounders (β = 0.24 ± 0.09, p < 0.01). This association was independent of AD biomarker positivity (i.e. increased t-tau/Aβ 42 ratio). Increasing age was associated with a higher likelihood of high-risk driving behaviors in individuals with AD brain pathology (β = 0.12 ± 0.04, p < 0.01), but a lower likelihood in individuals without AD brain pathology (β = -0.06 ± 0.03, p < 0.05). These findings suggest that adverse driving behaviors linked to a higher rate of traffic crashes in older adults are associated with sleep apnea severity and AD pathology even in cognitively unimpaired individuals. Further studies are needed to determine if treatment of sleep apnea decreases high-risk driving behaviors and therefore motor vehicle crashes. © The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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The Hydrocephalus Clinical Research Network quality improvement initiative: the role of antibiotic-impregnated catheters and vancomycin wound irrigation
(2022) Journal of Neurosurgery: Pediatrics, 29 (6), pp. 711-718.

Chu, J., Jensen, H., Holubkov, R., Krieger, M.D., Kulkarni, A.V., Riva-Cambrin, J., Rozzelle, C.J., Limbrick, D.D., Jr., Wellons, J.C., III, Browd, S.R., Whitehead, W.E., Pollack, I.F., Simon, T.D., Tamber, M.S., Hauptman, J.S., Pindrik, J., Naftel, R.P., McDonald, P.J., Hankinson, T.C., Jackson, E.M., Rocque, B.G., Reeder, R., Drake, J.M., Kestle, J.R.W., for the Hydrocephalus Clinical Research Network

AbstractOBJECTIVE Two previous Hydrocephalus Clinical Research Network (HCRN) studies have demonstrated that compliance with a standardized CSF shunt infection protocol reduces shunt infections. In this third iteration, a simplified protocol consisting of 5 steps was implemented. This analysis provides an updated evaluation of protocol compliance and evaluates modifiable shunt infection risk factors. METHODS The new simplified protocol was implemented at HCRN centers on November 1, 2016, for all shunt procedures, excluding external ventricular drains, ventricular reservoirs, and subgaleal shunts. Procedures performed through December 31, 2019, were included (38 months). Compliance with the protocol, use of antibiotic-impregnated catheters (AICs), and other variables of interest were collected at the index operation. Outcome events for a minimum of 6 months postoperatively were recorded. The definition of infection was unchanged from the authors’ previous report. RESULTS A total of 4913 procedures were performed at 13 HCRN centers. The overall infection rate was 5.1%. Surgeons were compliant with all 5 steps of the protocol in 79.4% of procedures. The infection rate for the protocol alone was 8.1% and dropped to 4.9% when AICs were added. Multivariate analysis identified having ≥ 2 complex chronic conditions (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.26–2.44, p = 0.01) and a history of prior shunt surgery within 12 weeks (OR 1.84, 95% CI 1.37–2.47, p < 0.01) as independent risk factors for shunt infection. The use of AICs (OR 0.70, 95% CI 0.50–0.97, p = 0.05) and vancomycin irrigation (OR 0.36, 95% CI 0.21–0.62, p < 0.01) were identified as independent factors protective against shunt infection. CONCLUSIONS The authors report the third iteration of their quality improvement protocol to reduce the risk of shunt infection. Compliance with the protocol was high. These updated data suggest that the incorporation of AICs is an important, modifiable infection prevention measure. Vancomycin irrigation was also identified as a protective factor but requires further study to better understand its role in preventing shunt infection. ©AANS 2022

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Assessment of Instrumental Activities of Daily Living in Preclinical Alzheimer Disease(2022) OTJR Occupation, Participation and Health, .

Keleman, A.A., Bollinger, R.M., Wisch, J.K., Grant, E.A., Benzinger, T.L., Ances, B.M., Stark, S.L.

AbstractQuestionnaires are used to assess instrumental activities of daily living (IADL) among individuals with preclinical Alzheimer disease (AD). They have indicated no functional impairment among this population. We aim to determine among cognitively normal (CN) older adults with and without preclinical AD whether: (a) performance-based IADL assessment measures a wider range of function than an IADL questionnaire and (b) biomarkers of AD are associated with IADL performance. In this cross-sectional analysis of 161 older adults, participants in studies of AD completed an IADL questionnaire, performance-based IADL assessment, cognitive assessments, and had biomarkers of AD (amyloid, hippocampal volume, brain network strength) assessed within 2 to 3 years. Performance-based IADL scores were more widely distributed compared with the IADL questionnaire. Smaller hippocampal volumes and reduced brain network connections were associated with worse IADL performance. A performance-based IADL assessment demonstrates functional impairment associated with neurodegeneration among CN older adults. © The Author(s) 2022.

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Posted on June 27, 2022
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