Marnina Stimmel - Academia.edu (original) (raw)
Papers by Marnina Stimmel
Nature medicine, Jun 4, 2024
Dementia is often undiagnosed in primary care, and even when diagnosed, untreated. The 5-Cog para... more Dementia is often undiagnosed in primary care, and even when diagnosed, untreated. The 5-Cog paradigm, a brief, culturally adept, cognitive detection tool paired with a clinical decision support may reduce barriers to improving dementia diagnosis and care. We performed a randomized controlled trial in primary care patients experiencing health disparities (racial/ethnic minorities and socioeconomically disadvantaged). Older adults with cognitive concerns were assigned in a 1:1 ratio to the 5-Cog paradigm or control. Primary outcome was improved dementia care actions defined as any of the following endpoints within 90 days: new mild cognitive impairment syndrome or dementia diagnoses as well as investigations, medications or specialist referrals ordered for cognitive indications. Groups were compared using intention-to-treat principles with multivariable logistic regression. Overall, 1,201 patients (mean age 72.8 years, 72% women and 94% Black, Hispanic or Latino) were enrolled and 599 were assigned to 5-Cog and 602 to the control. The 5-Cog paradigm demonstrated threefold odds of improvement in dementia care actions over control (odds ratio 3.43, 95% confidence interval 2.32-5.07). No serious intervention-related adverse events were reported. The 5-Cog paradigm improved diagnosis and management in patients with cognitive concerns and provides evidence to promote practice change to improve dementia care actions in primary care. ClinicalTrials.gov: NCT03816644. Dementia is common among older adults, with one in nine older Americans affected, and rates are increasing worldwide 1. Despite the availability of many cognitive assessment tools, dementia is often undiagnosed; over half of dementia cases are missed in primary care 2-4. This problem is more prevalent among older Black and Hispanic people than older white people in the United States 4-6. Barriers to implementing routine cognitive detection and related care actions in primary care are at the level of the instrument, patient, clinician and healthcare system 2,3,5,7-11. Many cognitive detection or diagnosis approaches are long, expensive, require clinicians to administer, need specialized equipment or do not provide guidance on the next steps following normal or abnormal results 5,9,12-14. Over a quarter of US residents belong to an ethnic minority such as Black, Hispanic or Latino (https://www.census.gov/quickfacts/ fact/table/US/PST045223), but many cognitive tests were developed in white populations 6,15. These tests, therefore, do not adequately account for cultural differences or health inequity 5,6,15. For example, we reported
Journal of the American Heart Association. Cardiovascular and cerebrovascular disease, Feb 14, 2024
Journal of the American Geriatrics Society, Jan 9, 2024
Journal of the International Neuropsychological Society, Oct 31, 2023
Archives of Clinical Neuropsychology, Sep 30, 2023
Archives of Clinical Neuropsychology, Sep 30, 2023
Archives of Clinical Neuropsychology, Sep 30, 2023
Archives of Clinical Neuropsychology
Objective Wernicke-Korsakoff syndrome (WKS) is a neurological disorder caused by the lack of thia... more Objective Wernicke-Korsakoff syndrome (WKS) is a neurological disorder caused by the lack of thiamine (vitamin B1) and includes Wernicke encephalopathy and the later stage of Korsakoff amnesic syndrome. WKS could be secondary to malnutrition, including Hyperemesis Gravidarum (HEG), which is characterized by severe vomiting during pregnancy. We present a case of HEG resulting in suspected WKS where neuropsychological evaluation clarified cognitive status with complex cultural, language, and educational factors. Method Repeat evaluations of a 29-year-old West-African* woman with mental status change, decreased verbal output, agitation, and inability to walk in the context of HEG. Initially referred for inpatient neuropsychological evaluation at 21 weeks gestation. MRI demonstrated mild diffuse cerebral atrophy and symmetric foci of T2 FLAIR hyperintensities in periaqueductal gray matter, hypothalamus, bilateral thalami, perirolandic cortex, and bilateral mammillary bodies. Results Ini...
Archives of Clinical Neuropsychology
Objective To demonstrate the validity of the Symbol Match in a diverse clinical setting. Backgrou... more Objective To demonstrate the validity of the Symbol Match in a diverse clinical setting. Background To improve detection of cognitive impairment in older primary care patients, our team developed the 5-Cog, a 5-minute cognitive assessment and decision tree paradigm that can be administered by non-clinicians. The Symbol Match is a new 90-second oral symbol and digit substitution task that is one of the three tests in the 5-Cog that assesses processing speed and executive function. Methods 50 participants (66% female; 44% Hispanic, 38% Non-Hispanic Black; 36% evaluated in Spanish) with a mean age of 77.84 ± 7.3, and 12 ± 4.7 mean years of education. Participants were recruited following clinical evaluations at the Montefiore Memory Disorder Centers and had confirmed clinical diagnoses of dementia, mild cognitive impairment (MCI), or subjective cognitive concerns (SCC). Results Symbol Match scores were significantly different (p < 0.001) between participants with SCC (N = 5, M = 48 ...
Archives of Clinical Neuropsychology
Objective Neuropsychiatric System Lupus Erythematosus (NP-SLE) is a subtype of SLE characterized ... more Objective Neuropsychiatric System Lupus Erythematosus (NP-SLE) is a subtype of SLE characterized by chronic or episodic neurologic and/or psychiatric central nervous system features. The neuropsychological profile of NP-SLE is not well-established. Here we present serial evaluations of a woman with confirmed NP-SLE who underwent subsequent medical intervention. This case study adds to the growing body of literature demonstrating the role neuropsychology plays in the care of patients with NP-SLE. Method This was an evaluation of a 25-year-old woman with NP-SLE. Initial testing took place inpatient prior to treatment with immunotherapy treatment subsequent evaluations were outpatient at 1 month, 4 months and 8 months post-treatment. Results Inpatient evaluation revealed a woman of at least average premorbid abilities with suboptimal performances across cognitive domains including reduced speed of processing and notable difficulty with planning and organization. Evaluation 1 month late...
Archives of Clinical Neuropsychology
Objective Autism Spectrum Disorder (ASD), Attention Deficit-Hyperactivity Disorder (ADHD), and ps... more Objective Autism Spectrum Disorder (ASD), Attention Deficit-Hyperactivity Disorder (ADHD), and psychotic traits, although highly comorbid, have rarely been studied in children. Existing research indicates that impulsivity, comprehension difficulties, and inflexibility are overlapping symptoms within the ASD and ADHD populations. Adult research shows high comorbidity estimates between ASD and psychosis. Here we describe the neuropsychological profile of a 14-year-old boy with diagnoses of ASD and ADHD with psychotic features. We highlight the value of comprehensive and flexible neuropsychological assessment while integrating detailed testing, behavioral observations, and collateral report. Methods Medical history of this child included late-term and breech birth with his first Apgar score at expected level and his second score falling below expected level. Delayed acquisition of developmental milestones, learning difficulties, speech difficulties, anxiety, and hyperactivity, were rep...
Archives of Clinical Neuropsychology
Introduction Language acculturation is the process by which a bilingual individual obtains profic... more Introduction Language acculturation is the process by which a bilingual individual obtains proficiency and comfort in speaking a new language while maintaining fluency in their native language. Considering the degree of language acculturation in bilingual patients is essential to choosing appropriate tests and interpreting neuropsychological assessment. The Language Acculturation Meter™ (LAM) was created for native Spanish speakers who are bilingual in English to aid in selecting and interpreting verbally-administered assessments. While the LAM was created to be completed as an interview, a Spanish version of the form exists and can be given to patients to complete independently. We sought to evaluate the feasibility and utility of self-administered LAM in a clinical older adult population in NY State. Methods The LAM was given to Spanish-speaking older adults and their caregivers as part of their clinical neuropsychological evaluation at Montefiore’s Memory Disorders Centers. 16 pa...
International journal of MS care, Mar 1, 2019
Background: Adherence to nonmedication recommendations is typically low, as seen in various healt... more Background: Adherence to nonmedication recommendations is typically low, as seen in various health populations. Because literature on adherence to treatment recommendations made after neuropsychological testing in multiple sclerosis (MS) is lacking, this study evaluated adherence and reasons for nonadherence. Relationships between adherence to recommendations and various other factors in patients with MS were also evaluated. Methods: Of 66 adult patients seen for neuropsychological testing at an MS center, 55 were eligible for this study. Forty-five patients (mean age, 43.4 years; 75.6% women) were reached by phone, and all agreed to an interview involving questions regarding adherence to treatment recommendations. Other information was obtained through retrospective medical record review. Results: Overall self-reported adherence to recommendations made from neuropsychological testing was 38%. Adherence rates varied by recommendation type: psychopharmacological management had the highest rate (80%), and referrals for cognitive rehabilitation had the lowest (6.5%). Reasons for nonadherence included needing more information and wanting to speak with one's physician regarding the recommendations. Adherence was associated with patients' ability to spontaneously recall at least some of their recommendations and with receiving both a written report and a phone call with test results. Conclusions: Adherence to recommendations made after neuropsychological testing for patients with MS is low. Points of intervention may be to give directed feedback for each recommendation and to provide both a written report and a phone call with results and recommendations. Asking patients to repeat back the recommendations may be a simple and efficient way to increase understanding and improve adherence.
Journal of The International Neuropsychological Society, Sep 5, 2022
Objective: Job loss is common in multiple sclerosis (MS) and frequently associated with depressio... more Objective: Job loss is common in multiple sclerosis (MS) and frequently associated with depression, fatigue, and cognitive dysfunction. Identifying these modifiable risk factors and providing “at-risk” women with a neuropsychologically-based intervention may improve employment outcomes. Our study seeks to investigate the utility of a neuropsychologically-based intervention with varying levels of treatment and follow-up, and evaluate treatment and employment outcomes among groups. Method: In this longitudinal, quasi-randomized controlled trial, employed women with MS meeting criteria on screening measures were considered “at-risk” for job instability and randomized to one of two neuropsychological testing interventions (standard-care group received testing and phone feedback of results and recommendations; experimental group received testing and in-person feedback with subsequent care-coordinator calls from a nurse to help coordinate recommendation completion). Participants who did not meet criteria were considered “low-risk” and only followed over time. Results: 56 women in the treatment groups (standard-care = 23; experimental = 33) and 63 women in the follow-only group were analyzed at 1 year. Rates of decreased employment were similar between standard-care (17.4%) and experimental (21.2%) groups (OR = .782, 95% CI .200–3.057). However, the experimental group completed significantly more treatment recommendations, t(53) = −3.237, p = .002. Rates of decreased employment were also similar between the “low-risk” (17.5%) and “at-risk” groups (19.6%), (OR = .721, 95% CI .285–1.826). Conclusion: Employment outcomes were similar at 1 year between treatment groups receiving differing levels of a neuropsychologically-based intervention, however treatment adherence significantly improved in the experimental group. Treatment groups also had similar employment outcomes as compared to a “low-risk,” no intervention group, suggesting that engaging in either neuropsychological intervention may have impacted job stability.
INTERNATIONAL NEUROLOGICAL JOURNAL, Sep 9, 2019
Background. Sexual dysfunction is a common problem in women with multiple sclerosis (MS). The Mul... more Background. Sexual dysfunction is a common problem in women with multiple sclerosis (MS). The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a specific instrument to evaluate sexual dysfunction in MS patients. The purpose of the study was to translate and validate the Ukrainian version of the MSISQ-19. Materials and methods. The original version of MSISQ-19 was translated under a standard procedure. A sample of 126 females with MS completed the questionnaire. Internal consistency was evaluated using Cronbach's alpha. Convergent validity was established using correlation with the Multiple Sclerosis Quality of Life-54 (MSQOL-54) and the Expanded Disability Status Scale (EDSS). Results. Total scale reliability (Cronbach's α = 0.943) and reliability for the primary (Cronbach's α = 0.901), secondary (Cronbach's α = 0.875), and tertiary subscales (Cronbach's α = 0.918) were high. Disability level, measured with the EDSS, and quality of life, measured with the MSQOL-54, significantly correlated with MSISQ-19 total score. Both physical and mental health-related quality of life on the MSQOL-54 significantly correlated with MSISQ-19 total score, and with primary, secondary, and tertiary sexual dysfunction. Satisfaction with sexual function significantly correlated with MSISQ-19 total score, and with primary, secondary, and tertiary sexual dysfunction. Conclusions. The study findings suggest that the Ukrainian version of the MSISQ-19 is a reliable and valid instrument for sexual function assessment in Ukrainian women with MS. It can be used during routine counseling to introduce the theme of sexuality, to detect sexual dysfunction, provide treatment, and prevent the development of more severe problems and therefore preserve the proper quality of life for MS patients.
JMIR Research Protocols
Background The southern India state of Kerala has among the highest proportion of older adults in... more Background The southern India state of Kerala has among the highest proportion of older adults in its population in the country. An increase in chronic age-related diseases such as dementia is expected in the older Kerala population. Identifying older individuals early in the course of cognitive decline offers the best hope of introducing preventive measures early and planning management. However, the epidemiology and pathogenesis of predementia syndromes at the early stages of cognitive decline in older adults are not well established in India. Objective The Kerala Einstein Study (KES) is a community-based cohort study that was established in 2008 and is based in the Kozhikode district in Kerala state. KES aims to establish risk factors and brain substrates of motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the presence of slow gait and subjective cognitive concerns in individuals without dementia or disability. This protocol describes the study desig...
Journal of the International Neuropsychological Society
Objective: Job loss is common in multiple sclerosis (MS) and frequently associated with depressio... more Objective: Job loss is common in multiple sclerosis (MS) and frequently associated with depression, fatigue, and cognitive dysfunction. Identifying these modifiable risk factors and providing “at-risk” women with a neuropsychologically-based intervention may improve employment outcomes. Our study seeks to investigate the utility of a neuropsychologically-based intervention with varying levels of treatment and follow-up, and evaluate treatment and employment outcomes among groups. Method: In this longitudinal, quasi-randomized controlled trial, employed women with MS meeting criteria on screening measures were considered “at-risk” for job instability and randomized to one of two neuropsychological testing interventions (standard-care group received testing and phone feedback of results and recommendations; experimental group received testing and in-person feedback with subsequent care-coordinator calls from a nurse to help coordinate recommendation completion). Participants who did n...
Archives of Clinical Neuropsychology, 2021
Quick cognitive screeners which can be used for ethnically and educationally diverse patients are... more Quick cognitive screeners which can be used for ethnically and educationally diverse patients are particularly useful within the primary care setting. The Picture-Based Memory Impairment Screen (PMIS) is a brief screening tool which has been validated in such a population. Here we compare the PMIS against a gold-standard memory task (Hopkins Verbal Learning Test-Revised [HVLT-R]) and evaluate its utility as a stand-alone memory screener. In this cross-sectional study, adults over 65 with cognitive concerns were recruited at their primary care visit to complete the PMIS as part of a larger randomized controlled trial aimed at improving detection of cognitive impairment. A subset of those participants also agreed to complete neuropsychological testing in English or Spanish (including the HVLT-R). Correlations were performed. 108 participants (Mean age = 73; 73% female; 39% Black/AA; 58% Hispanic; 52% evaluated in Spanish; Mean years education = 10.8) completed the PMIS and HVLT-R. The...
Archives of Clinical Neuropsychology, 2018
Adherence to medication in multiple sclerosis (MS) is sub-optimal (65-80%). Treatment adherence, ... more Adherence to medication in multiple sclerosis (MS) is sub-optimal (65-80%). Treatment adherence, (i.e., keeping appointments), has rarely been evaluated in MS. The following study seeks to identify rates of adherence to a neuropsychological intervention among employed women with MS. Predictors of missing appointments and dropping out of the intervention are examined. Method: Our study includes 69 women with MS who took part in an employment study (April 2016-January 2018) that sought to maintain employment through a neuropsychological testing intervention. Participants were screened during a clinic visit to their neurologist (Teaneck NJ). Women who indicated elevated fatigue (Fatigue Severity Scale; FSS), depression (Patient Health Questionnaire; PHQ), and/or cognitive dysfunction (Symbol Digit Modalities Test; SDMT) were included in the employment study and contacted to make appointments for neuropsychological testing. Patients' number of missed appointments and dropout rates were evaluated. Results: 34.8% (N = 24) of employed women dropped out of this study. Of 58 women who were scheduled for neuropsychological testing, 44.8% (N = 26) missed at least one appointment. Using logistic regression, neither fatigue nor depression significantly predicted missing NP testing appointments or dropping out. Neurocognitive functioning, however, significantly predicted both the likelihood of missing a neuropsychological testing appointment (CI = .881-.994, p = .032) and of dropping out of the study (CI = .876-.983, p = .011). Conclusions: Neurocognitive slowing predicted non-adherence and dropping out of a neuropsychological testing intervention. This study reflects an objective measure of treatment adherence (i.e., physician appointments) among employed women with MS and suggests that women who are slower on the SDMT may be at greater risk for non-adherence.
Clinical Rehabilitation, 2020
Objective: To evaluate feasibility and acceptability of a neuropsychologically-based vocational i... more Objective: To evaluate feasibility and acceptability of a neuropsychologically-based vocational intervention with increased follow-up support for women with multiple sclerosis. Design: Single-blinded parallel-group randomized controlled trial with 12-month follow-up. Setting: Tertiary-care multiple sclerosis center. Participants: Forty-nine employed women with multiple sclerosis meeting criteria on measures of cognitive dysfunction (Symbol Digit Modalities Test), fatigue (Fatigue Severity Scale), and/or depression (Beck Depression Inventory/Patient Health Questionnaire). Interventions: Participants received either neuropsychological testing and phone feedback regarding findings and tailored recommendations (standard-care treatment), or testing, in-person feedback, and two calls from a care-coordinator (experimental treatment). Measures: Feasibility measures included enrollment and attrition rates, and compliance to recommendations at 12-months between groups. Acceptability was evalu...
Nature medicine, Jun 4, 2024
Dementia is often undiagnosed in primary care, and even when diagnosed, untreated. The 5-Cog para... more Dementia is often undiagnosed in primary care, and even when diagnosed, untreated. The 5-Cog paradigm, a brief, culturally adept, cognitive detection tool paired with a clinical decision support may reduce barriers to improving dementia diagnosis and care. We performed a randomized controlled trial in primary care patients experiencing health disparities (racial/ethnic minorities and socioeconomically disadvantaged). Older adults with cognitive concerns were assigned in a 1:1 ratio to the 5-Cog paradigm or control. Primary outcome was improved dementia care actions defined as any of the following endpoints within 90 days: new mild cognitive impairment syndrome or dementia diagnoses as well as investigations, medications or specialist referrals ordered for cognitive indications. Groups were compared using intention-to-treat principles with multivariable logistic regression. Overall, 1,201 patients (mean age 72.8 years, 72% women and 94% Black, Hispanic or Latino) were enrolled and 599 were assigned to 5-Cog and 602 to the control. The 5-Cog paradigm demonstrated threefold odds of improvement in dementia care actions over control (odds ratio 3.43, 95% confidence interval 2.32-5.07). No serious intervention-related adverse events were reported. The 5-Cog paradigm improved diagnosis and management in patients with cognitive concerns and provides evidence to promote practice change to improve dementia care actions in primary care. ClinicalTrials.gov: NCT03816644. Dementia is common among older adults, with one in nine older Americans affected, and rates are increasing worldwide 1. Despite the availability of many cognitive assessment tools, dementia is often undiagnosed; over half of dementia cases are missed in primary care 2-4. This problem is more prevalent among older Black and Hispanic people than older white people in the United States 4-6. Barriers to implementing routine cognitive detection and related care actions in primary care are at the level of the instrument, patient, clinician and healthcare system 2,3,5,7-11. Many cognitive detection or diagnosis approaches are long, expensive, require clinicians to administer, need specialized equipment or do not provide guidance on the next steps following normal or abnormal results 5,9,12-14. Over a quarter of US residents belong to an ethnic minority such as Black, Hispanic or Latino (https://www.census.gov/quickfacts/ fact/table/US/PST045223), but many cognitive tests were developed in white populations 6,15. These tests, therefore, do not adequately account for cultural differences or health inequity 5,6,15. For example, we reported
Journal of the American Heart Association. Cardiovascular and cerebrovascular disease, Feb 14, 2024
Journal of the American Geriatrics Society, Jan 9, 2024
Journal of the International Neuropsychological Society, Oct 31, 2023
Archives of Clinical Neuropsychology, Sep 30, 2023
Archives of Clinical Neuropsychology, Sep 30, 2023
Archives of Clinical Neuropsychology, Sep 30, 2023
Archives of Clinical Neuropsychology
Objective Wernicke-Korsakoff syndrome (WKS) is a neurological disorder caused by the lack of thia... more Objective Wernicke-Korsakoff syndrome (WKS) is a neurological disorder caused by the lack of thiamine (vitamin B1) and includes Wernicke encephalopathy and the later stage of Korsakoff amnesic syndrome. WKS could be secondary to malnutrition, including Hyperemesis Gravidarum (HEG), which is characterized by severe vomiting during pregnancy. We present a case of HEG resulting in suspected WKS where neuropsychological evaluation clarified cognitive status with complex cultural, language, and educational factors. Method Repeat evaluations of a 29-year-old West-African* woman with mental status change, decreased verbal output, agitation, and inability to walk in the context of HEG. Initially referred for inpatient neuropsychological evaluation at 21 weeks gestation. MRI demonstrated mild diffuse cerebral atrophy and symmetric foci of T2 FLAIR hyperintensities in periaqueductal gray matter, hypothalamus, bilateral thalami, perirolandic cortex, and bilateral mammillary bodies. Results Ini...
Archives of Clinical Neuropsychology
Objective To demonstrate the validity of the Symbol Match in a diverse clinical setting. Backgrou... more Objective To demonstrate the validity of the Symbol Match in a diverse clinical setting. Background To improve detection of cognitive impairment in older primary care patients, our team developed the 5-Cog, a 5-minute cognitive assessment and decision tree paradigm that can be administered by non-clinicians. The Symbol Match is a new 90-second oral symbol and digit substitution task that is one of the three tests in the 5-Cog that assesses processing speed and executive function. Methods 50 participants (66% female; 44% Hispanic, 38% Non-Hispanic Black; 36% evaluated in Spanish) with a mean age of 77.84 ± 7.3, and 12 ± 4.7 mean years of education. Participants were recruited following clinical evaluations at the Montefiore Memory Disorder Centers and had confirmed clinical diagnoses of dementia, mild cognitive impairment (MCI), or subjective cognitive concerns (SCC). Results Symbol Match scores were significantly different (p < 0.001) between participants with SCC (N = 5, M = 48 ...
Archives of Clinical Neuropsychology
Objective Neuropsychiatric System Lupus Erythematosus (NP-SLE) is a subtype of SLE characterized ... more Objective Neuropsychiatric System Lupus Erythematosus (NP-SLE) is a subtype of SLE characterized by chronic or episodic neurologic and/or psychiatric central nervous system features. The neuropsychological profile of NP-SLE is not well-established. Here we present serial evaluations of a woman with confirmed NP-SLE who underwent subsequent medical intervention. This case study adds to the growing body of literature demonstrating the role neuropsychology plays in the care of patients with NP-SLE. Method This was an evaluation of a 25-year-old woman with NP-SLE. Initial testing took place inpatient prior to treatment with immunotherapy treatment subsequent evaluations were outpatient at 1 month, 4 months and 8 months post-treatment. Results Inpatient evaluation revealed a woman of at least average premorbid abilities with suboptimal performances across cognitive domains including reduced speed of processing and notable difficulty with planning and organization. Evaluation 1 month late...
Archives of Clinical Neuropsychology
Objective Autism Spectrum Disorder (ASD), Attention Deficit-Hyperactivity Disorder (ADHD), and ps... more Objective Autism Spectrum Disorder (ASD), Attention Deficit-Hyperactivity Disorder (ADHD), and psychotic traits, although highly comorbid, have rarely been studied in children. Existing research indicates that impulsivity, comprehension difficulties, and inflexibility are overlapping symptoms within the ASD and ADHD populations. Adult research shows high comorbidity estimates between ASD and psychosis. Here we describe the neuropsychological profile of a 14-year-old boy with diagnoses of ASD and ADHD with psychotic features. We highlight the value of comprehensive and flexible neuropsychological assessment while integrating detailed testing, behavioral observations, and collateral report. Methods Medical history of this child included late-term and breech birth with his first Apgar score at expected level and his second score falling below expected level. Delayed acquisition of developmental milestones, learning difficulties, speech difficulties, anxiety, and hyperactivity, were rep...
Archives of Clinical Neuropsychology
Introduction Language acculturation is the process by which a bilingual individual obtains profic... more Introduction Language acculturation is the process by which a bilingual individual obtains proficiency and comfort in speaking a new language while maintaining fluency in their native language. Considering the degree of language acculturation in bilingual patients is essential to choosing appropriate tests and interpreting neuropsychological assessment. The Language Acculturation Meter™ (LAM) was created for native Spanish speakers who are bilingual in English to aid in selecting and interpreting verbally-administered assessments. While the LAM was created to be completed as an interview, a Spanish version of the form exists and can be given to patients to complete independently. We sought to evaluate the feasibility and utility of self-administered LAM in a clinical older adult population in NY State. Methods The LAM was given to Spanish-speaking older adults and their caregivers as part of their clinical neuropsychological evaluation at Montefiore’s Memory Disorders Centers. 16 pa...
International journal of MS care, Mar 1, 2019
Background: Adherence to nonmedication recommendations is typically low, as seen in various healt... more Background: Adherence to nonmedication recommendations is typically low, as seen in various health populations. Because literature on adherence to treatment recommendations made after neuropsychological testing in multiple sclerosis (MS) is lacking, this study evaluated adherence and reasons for nonadherence. Relationships between adherence to recommendations and various other factors in patients with MS were also evaluated. Methods: Of 66 adult patients seen for neuropsychological testing at an MS center, 55 were eligible for this study. Forty-five patients (mean age, 43.4 years; 75.6% women) were reached by phone, and all agreed to an interview involving questions regarding adherence to treatment recommendations. Other information was obtained through retrospective medical record review. Results: Overall self-reported adherence to recommendations made from neuropsychological testing was 38%. Adherence rates varied by recommendation type: psychopharmacological management had the highest rate (80%), and referrals for cognitive rehabilitation had the lowest (6.5%). Reasons for nonadherence included needing more information and wanting to speak with one's physician regarding the recommendations. Adherence was associated with patients' ability to spontaneously recall at least some of their recommendations and with receiving both a written report and a phone call with test results. Conclusions: Adherence to recommendations made after neuropsychological testing for patients with MS is low. Points of intervention may be to give directed feedback for each recommendation and to provide both a written report and a phone call with results and recommendations. Asking patients to repeat back the recommendations may be a simple and efficient way to increase understanding and improve adherence.
Journal of The International Neuropsychological Society, Sep 5, 2022
Objective: Job loss is common in multiple sclerosis (MS) and frequently associated with depressio... more Objective: Job loss is common in multiple sclerosis (MS) and frequently associated with depression, fatigue, and cognitive dysfunction. Identifying these modifiable risk factors and providing “at-risk” women with a neuropsychologically-based intervention may improve employment outcomes. Our study seeks to investigate the utility of a neuropsychologically-based intervention with varying levels of treatment and follow-up, and evaluate treatment and employment outcomes among groups. Method: In this longitudinal, quasi-randomized controlled trial, employed women with MS meeting criteria on screening measures were considered “at-risk” for job instability and randomized to one of two neuropsychological testing interventions (standard-care group received testing and phone feedback of results and recommendations; experimental group received testing and in-person feedback with subsequent care-coordinator calls from a nurse to help coordinate recommendation completion). Participants who did not meet criteria were considered “low-risk” and only followed over time. Results: 56 women in the treatment groups (standard-care = 23; experimental = 33) and 63 women in the follow-only group were analyzed at 1 year. Rates of decreased employment were similar between standard-care (17.4%) and experimental (21.2%) groups (OR = .782, 95% CI .200–3.057). However, the experimental group completed significantly more treatment recommendations, t(53) = −3.237, p = .002. Rates of decreased employment were also similar between the “low-risk” (17.5%) and “at-risk” groups (19.6%), (OR = .721, 95% CI .285–1.826). Conclusion: Employment outcomes were similar at 1 year between treatment groups receiving differing levels of a neuropsychologically-based intervention, however treatment adherence significantly improved in the experimental group. Treatment groups also had similar employment outcomes as compared to a “low-risk,” no intervention group, suggesting that engaging in either neuropsychological intervention may have impacted job stability.
INTERNATIONAL NEUROLOGICAL JOURNAL, Sep 9, 2019
Background. Sexual dysfunction is a common problem in women with multiple sclerosis (MS). The Mul... more Background. Sexual dysfunction is a common problem in women with multiple sclerosis (MS). The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a specific instrument to evaluate sexual dysfunction in MS patients. The purpose of the study was to translate and validate the Ukrainian version of the MSISQ-19. Materials and methods. The original version of MSISQ-19 was translated under a standard procedure. A sample of 126 females with MS completed the questionnaire. Internal consistency was evaluated using Cronbach's alpha. Convergent validity was established using correlation with the Multiple Sclerosis Quality of Life-54 (MSQOL-54) and the Expanded Disability Status Scale (EDSS). Results. Total scale reliability (Cronbach's α = 0.943) and reliability for the primary (Cronbach's α = 0.901), secondary (Cronbach's α = 0.875), and tertiary subscales (Cronbach's α = 0.918) were high. Disability level, measured with the EDSS, and quality of life, measured with the MSQOL-54, significantly correlated with MSISQ-19 total score. Both physical and mental health-related quality of life on the MSQOL-54 significantly correlated with MSISQ-19 total score, and with primary, secondary, and tertiary sexual dysfunction. Satisfaction with sexual function significantly correlated with MSISQ-19 total score, and with primary, secondary, and tertiary sexual dysfunction. Conclusions. The study findings suggest that the Ukrainian version of the MSISQ-19 is a reliable and valid instrument for sexual function assessment in Ukrainian women with MS. It can be used during routine counseling to introduce the theme of sexuality, to detect sexual dysfunction, provide treatment, and prevent the development of more severe problems and therefore preserve the proper quality of life for MS patients.
JMIR Research Protocols
Background The southern India state of Kerala has among the highest proportion of older adults in... more Background The southern India state of Kerala has among the highest proportion of older adults in its population in the country. An increase in chronic age-related diseases such as dementia is expected in the older Kerala population. Identifying older individuals early in the course of cognitive decline offers the best hope of introducing preventive measures early and planning management. However, the epidemiology and pathogenesis of predementia syndromes at the early stages of cognitive decline in older adults are not well established in India. Objective The Kerala Einstein Study (KES) is a community-based cohort study that was established in 2008 and is based in the Kozhikode district in Kerala state. KES aims to establish risk factors and brain substrates of motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the presence of slow gait and subjective cognitive concerns in individuals without dementia or disability. This protocol describes the study desig...
Journal of the International Neuropsychological Society
Objective: Job loss is common in multiple sclerosis (MS) and frequently associated with depressio... more Objective: Job loss is common in multiple sclerosis (MS) and frequently associated with depression, fatigue, and cognitive dysfunction. Identifying these modifiable risk factors and providing “at-risk” women with a neuropsychologically-based intervention may improve employment outcomes. Our study seeks to investigate the utility of a neuropsychologically-based intervention with varying levels of treatment and follow-up, and evaluate treatment and employment outcomes among groups. Method: In this longitudinal, quasi-randomized controlled trial, employed women with MS meeting criteria on screening measures were considered “at-risk” for job instability and randomized to one of two neuropsychological testing interventions (standard-care group received testing and phone feedback of results and recommendations; experimental group received testing and in-person feedback with subsequent care-coordinator calls from a nurse to help coordinate recommendation completion). Participants who did n...
Archives of Clinical Neuropsychology, 2021
Quick cognitive screeners which can be used for ethnically and educationally diverse patients are... more Quick cognitive screeners which can be used for ethnically and educationally diverse patients are particularly useful within the primary care setting. The Picture-Based Memory Impairment Screen (PMIS) is a brief screening tool which has been validated in such a population. Here we compare the PMIS against a gold-standard memory task (Hopkins Verbal Learning Test-Revised [HVLT-R]) and evaluate its utility as a stand-alone memory screener. In this cross-sectional study, adults over 65 with cognitive concerns were recruited at their primary care visit to complete the PMIS as part of a larger randomized controlled trial aimed at improving detection of cognitive impairment. A subset of those participants also agreed to complete neuropsychological testing in English or Spanish (including the HVLT-R). Correlations were performed. 108 participants (Mean age = 73; 73% female; 39% Black/AA; 58% Hispanic; 52% evaluated in Spanish; Mean years education = 10.8) completed the PMIS and HVLT-R. The...
Archives of Clinical Neuropsychology, 2018
Adherence to medication in multiple sclerosis (MS) is sub-optimal (65-80%). Treatment adherence, ... more Adherence to medication in multiple sclerosis (MS) is sub-optimal (65-80%). Treatment adherence, (i.e., keeping appointments), has rarely been evaluated in MS. The following study seeks to identify rates of adherence to a neuropsychological intervention among employed women with MS. Predictors of missing appointments and dropping out of the intervention are examined. Method: Our study includes 69 women with MS who took part in an employment study (April 2016-January 2018) that sought to maintain employment through a neuropsychological testing intervention. Participants were screened during a clinic visit to their neurologist (Teaneck NJ). Women who indicated elevated fatigue (Fatigue Severity Scale; FSS), depression (Patient Health Questionnaire; PHQ), and/or cognitive dysfunction (Symbol Digit Modalities Test; SDMT) were included in the employment study and contacted to make appointments for neuropsychological testing. Patients' number of missed appointments and dropout rates were evaluated. Results: 34.8% (N = 24) of employed women dropped out of this study. Of 58 women who were scheduled for neuropsychological testing, 44.8% (N = 26) missed at least one appointment. Using logistic regression, neither fatigue nor depression significantly predicted missing NP testing appointments or dropping out. Neurocognitive functioning, however, significantly predicted both the likelihood of missing a neuropsychological testing appointment (CI = .881-.994, p = .032) and of dropping out of the study (CI = .876-.983, p = .011). Conclusions: Neurocognitive slowing predicted non-adherence and dropping out of a neuropsychological testing intervention. This study reflects an objective measure of treatment adherence (i.e., physician appointments) among employed women with MS and suggests that women who are slower on the SDMT may be at greater risk for non-adherence.
Clinical Rehabilitation, 2020
Objective: To evaluate feasibility and acceptability of a neuropsychologically-based vocational i... more Objective: To evaluate feasibility and acceptability of a neuropsychologically-based vocational intervention with increased follow-up support for women with multiple sclerosis. Design: Single-blinded parallel-group randomized controlled trial with 12-month follow-up. Setting: Tertiary-care multiple sclerosis center. Participants: Forty-nine employed women with multiple sclerosis meeting criteria on measures of cognitive dysfunction (Symbol Digit Modalities Test), fatigue (Fatigue Severity Scale), and/or depression (Beck Depression Inventory/Patient Health Questionnaire). Interventions: Participants received either neuropsychological testing and phone feedback regarding findings and tailored recommendations (standard-care treatment), or testing, in-person feedback, and two calls from a care-coordinator (experimental treatment). Measures: Feasibility measures included enrollment and attrition rates, and compliance to recommendations at 12-months between groups. Acceptability was evalu...