The Charted Care Collection (12/07/2021)

December 7, 2021 Jessica Kluetz

The Chartered Care Collection (12/07/2021)

The Chartered Care Collection provides a review of the latest, pertinent publications from the medical literature on aging. I have selected interesting articles that describe some of the most current research that may be relevant to the loved one in your care. Each article will be referenced if you desire to read more of the study, but I will give a brief synopsis of each study so you are aware of the latest research. Let’s get to The Collection!

The Chartered Care Collection

It’s amazing how time flies. We are now into December, which means at my house, we are already knee deep in the holiday festivities. I wanted to take a pause, however, and give a run through of the latest published scientific research. Hopefully you will take a little break from your baking, gift wrapping, or whatever activities might be the tradition of your home and learn about some new research.

The first study by Anders and colleagues looks at the relationship between high intensity resistance exercise and cognition. I have spent the past few posts discussing aspects of this with healthy aging. Previous research has looked at moderate intensity aerobic exercise and its improvements on measures of cognitive function. This study specifically looks at high intensity exercise’s effect. Each participant was assessed for their one repetition maximum for a back squat, The exercise then involved 5-10 repetitions of 40-60% of the maximum and then a set with progressively heavier loads until the participant hit failure. Cognition was then assessed through various cognition tests. The findings were very interesting in that the results showed that high intensity exercise might improve reaction time and processing speed but can worsen performance in tasks that require memory and recall.

(Related blog post: Mobility, A Prong Of Healthy Aging)

Moving on to the next study, published in the Journal of Neurology, Neurosurgery and Psychiatry, looked at the direct contribution of oral anticoagulants (OAC), aka blood thinners, on intracerebral hemorrhage (ICH). The study enrolled adult patients with atrial fibrillation who were started on OAC to prevent a stroke. Baseline brain MRIs were obtained of all of the participants. Through following patients on OACs, it found that small vessel disease is associated with ICH in those on OACs at the time of their stroke. Small vessel disease is an independent predictor for ICH in patients on oral anticoagulation to prevent stroke from atrial fibrillation. This would be something to discuss with a prescribing physician treating a loved one with atrial fibrillation.

Next, a topic always near and dear to me, rehabilitation after stroke. This study by Moore specifically looked at the recovery of visuospatial neglect after a stroke. This is a very common consequence of stroke, so the researchers wanted to see if there was a relationship of the amount of neglect to the recovery of functional outcome. There were 400 participants. Just over a third had significant neglect immediately after their strokes. Of those participants, half had a type of neglect, termed egocentric. This type of neglect is apparent when objects are neglected relative to its position. For instance, objects that fall to the left side of a dividing line will be neglected. Another quarter of the patients with neglect had allocentric neglect. This type of neglect involves neglect occurring in relation to the object itself, regardless of its position relative to a dividing line. So in this case, the left side of an object is neglected even if the object was entirely located on the right side of a page. The remaining quarter of those participants with neglect display both egocentric and allocentric neglect. Six months later their recovery was assessed. Sixty-nine percent of the cases had fully recovered in terms of their neglect. The remaining participants had varying levels of recovery. An analysis of the recovery found that allocentric neglect was a significant predictor of poor long-term functional outcome. So if you have a loved one who has experienced a stroke and seems to have some level of neglect, you can discuss with his speech therapist or occupational therapist what sort of neglect he has and how severe it might be. This can possibly give some guidance as to what sort of functional recovery might be expected.

(Related blog post: Recovery After Stroke)

The last study I wanted to highlight covered physical rehabilitation for the elderly who are hospitalized with heart failure. For a loved one needing rehabilitation after a heart failure diagnosis, it can be difficult for insurance to authorize inpatient stays. This study, published in The New England Journal of Medicine, looked at outpatient rehabilitation following the hospitalization. The subjects of the study were started in the rehabilitation program as an inpatient before even discharging to home. Upon discharge, they were placed in a progressive physical rehabilitation program in the outpatient setting. Sessions were 60 minutes, three days a week for 12 weeks. Those that underwent this rehabilitation intervention showed statistically significant better outcomes in a physical performance testing compared to those who did not undergo the rehabilitation program. In addition, those receiving early rehab also had reduced hospital readmission compared to those who did not undergo the rehab program.

(Related blog post: Where Do You Go After Acute Rehab?)

References:

Anders, J., et al. Acute Effects of High-intensity Resistance Exercise on Cognitive Function. J Sports Sci Med. 2021, September; 20(3):391-397.

Seiffge, D., et al. Small Vessel Disease Burden and Intracerebral Hemorrhage in Patients Taking Oral Anticoagulants. J Neurol Neurosurg Psych. 2021, August; 92(8): 805-814.

Moore, M., et al. Recovery of Visuospatial Neglect Subtypes and Relationship to Functional Outcome Six Months after Stroke. Neurorehabil Neural Repair. 2021. https://dio.org/10.1177/15459683211032977.

Kitzman, D.,, et al. Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. N Engl J Med. 2021, June 15; 385(3):203-216.

That sums it up for the Chartered Care Collection for this month. Take the time to read each of these articles in full, and feel free to leave your comments or questions below!