レボウイッツ アダム

Background Amyloid-β (Aβ) deposit prediction accuracy is necessary for clinicians treating patients desiring Alzheimer's disease (AD) modifying drugs. Aβ-PET imaging is useful for diagnosis, but high in cost compared to brain perfusion SPECT. However, SPECT displays regional cerebral blood flow (rCBF) and does not detect Aβ deposits, therefore requiring additional clinical information. Objective This article describes a novel statistical method to predict amyloid deposits via PET images (Aβ+ or Aβ−) using the three indices of the ^99m Tc-ECD SPECT – severity, extend, and ratio – for the three ROIs. Methods Candidate patients (N = 114 patients [55% male], 81 Aβ+ 33 Aβ−, mean age 74.2 ± 6.6 years, mean MMSE score 23.7 ± 2.8) underwent MRI and ^99m Tc-ECD SPECT scanning. After examining SPECT index, demographic, and age data, age and sex were treated as confounders in one, two, and three-index logistic additive models with severity, extend, and ratio as explanatory variables. Area under curve (AUC), sensitivity and specificity were used as statistical indices for model fitness and accuracies. Three-hold cross validation analyses were conducted to evaluate error rates. Results According to ROC analysis, best scores for fitness and accuracy were obtained from the three-index model with patients’ age and sex for the configured ROIs including precuneus, posterior cingulate and temporal-parietal region of SPECT (AUC: 0.818, Sensitivity: 0.803, Specificity: 0.727). Conclusions This technique using ^99m Tc-ECD SPECT data can predict amyloid deposits with acceptable accuracy. To confirm the reliability and validity, a multicenter SPECT study is needed.

Background: Interventions to prevent or attenuate cognitive decline and dementia in older adults are becoming increasingly important. Recently, cognitive training exercise can be via computer or mobile technology for independent or home use. Recent meta-analysis has reported that Computerized Cognitive Training (CCT) is effective at enhancing cognitive function in healthy older and Alzheimer’s disease adults, although little is known about individual characteristics of each computerized program. Objective: We developed a new CCT named Brain Training Based on Everyday Living (BTEL) to enhance cognitive capacity for Instrumental Activities of Daily Living (IADL). We aim to evaluate the efficacy of the BTEL among cognitively healthy old individuals and to explore its concurrent validity and construct concept. Methods: We conducted a double-blind study where 106 individuals aged 65 years and older (intervened = 53, control = 53) worked on the active and placebo tasks three times a week over three months (clinical trial: UMIN000048730). The main results were examined using ANCOVA and calculating correlation coefficients. Results: We found no effect on total score of the three tests; however, there was significant effect for the BTEL on: recognition in MMSE, and immediate recall in HDSR. The tasks are associated with prefrontal cortex. In addition, correlations indicated that each BTEL domain had some validity as a cognitive assessment tool. Different from previous CCT, we determined the neuropsychological characteristics of specific cognitive tasks of the BTEL to a certain degree. Conclusions: We found modest efficacy of the BTEL in cognitively healthy old individuals and confirmed its concurrent validity and the conceptual construct.

Aim: To translate the Rushton Moral Resilience Scale (RMRS) into Japanese and validate its applicability among Japanese healthcare professionals. Background: To overcome daily challenges in the field of healthcare, in which moral difficulties are routinely encountered, the development of intervention methods to address moral suffering and moral distress is crucial. Methods: We conducted a cross‐sectional survey using a web‐based questionnaire. The RMRS‐16 was translated into Japanese and confirmed through back‐translation. Reliability analyses (Cronbach’s alpha and intraclass correlation coefficient [ICC]), confirmatory factor analyses (CFAs), correlation analyses, t‐tests, and analysis of variance (ANOVA) were used to assess the validity of the scale. Results: Participants comprised 1295 healthcare professionals, including 498 nurses. All subscales and the total scale had acceptable reliability values (α ≥ 0.70). CFA supported the original four‐factor structure (response to moral adversity, personal integrity, relational integrity, and moral efficacy), with acceptable fit indices. The ANOVA results suggested that, among Japanese healthcare professionals, nurses and individuals from other professions showed lower average moral resilience scores compared to physicians, consistent with previous research on mental health and moral distress. In addition, women scored lower for moral resilience than men. However, the ICC values for the subscales of the RMRS were below acceptable levels, and the results of the standardized residual covariances also suggested a model misfit. Conclusion and Implications: The reliability, validity, and utility of the Japanese version of the RMRS were generally supported. However, there were areas at the item level that required structural examination. The current findings suggest that there are cultural differences in the concept of moral resilience. Therefore, for future cultural comparisons, the original four‐factor structure was maintained in the Japanese version without modifications. Further conceptual development of moral resilience is needed in Japanese healthcare.