Publications (9)23.23 Total impact
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Article: Higher cortisol predicts less improvement in verbal memory performance after cardiac rehabilitation in patients with coronary artery disease.
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ABSTRACT: Objective. While physical activity can improve verbal memory performance in subjects with coronary artery disease (CAD), there is large variability in response. Elevated cortisol production has been suggested to negatively affect verbal memory performance, yet cortisol concentrations have not been assessed as a predictor of response to exercise intervention in those with CAD. Methods. CAD patients participating in a one-year cardiac rehabilitation program were recruited. Memory was assessed with the California Verbal Learning Test second edition at baseline and one year. Cortisol was measured from a 20 mg, 3.0 cm hair sample collected at baseline. Results. In patients with CAD (n = 56, mean ± SD age = 66 ± 11, 86% male), higher cortisol (hair cortisol concentrations ≥ 153.2 ng/g) significantly predicted less memory improvement (F(1,50) = 5.50, P = 0.02) when controlling for age (F(1,50) = 0.17, P = 0.68), gender (F(1,50) = 2.51, P = 0.12), maximal oxygen uptake (F(1,50) = 1.88, P = 0.18), and body mass index (F(1,50) = 3.25, P = 0.08). Conclusion. Prolonged hypothalamic pituitary adrenal axis activation may interfere with exercise-related improvements in memory in CAD.Cardiovascular Psychiatry and Neurology 01/2013; 2013:340342. -
Article: Verbal memory performance and completion of cardiac rehabilitation in patients with coronary artery disease.
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ABSTRACT: To assess cognitive performance as a predictor of noncompletion of cardiac rehabilitation (CR) using a standardized verbal memory test. This was a prospective cohort study of consecutive patients with coronary artery disease (n = 131) entering 1-year outpatient CR between April 2007 and May 2009. Verbal memory performance was assessed using the California Verbal Learning Test, Second Edition. Attendance at weekly CR sessions was recorded, and completion or noncompletion was determined according to comprehensive CR criteria. Depression was diagnosed according to DSM-IV criteria as a possible confounder. Verbal memory performance at entry into CR differed significantly (F(1,130) = 7.80, p = .006) between noncompleters and completers (mean [SD] cumulative California Verbal Learning Test, Second Edition, score, -1.15 [2.59] versus 0.47 [3.12]) in analysis of covariance controlling for pertinent clinical confounders. Better verbal memory performance predicted a reduced risk of noncompletion (hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.77-0.96, p = .009) in time-to-event analysis adjusted for depression (HR = 2.62, 95% CI = 1.33-5.17, p = .006) and smoking history (HR = 2.03, 95% CI = 0.98-4.22, p = .06). A post hoc analysis suggested that better verbal memory performance predicted a reduced risk of noncompletion for medical reasons (HR = 0.83, 95% CI = 0.70-0.99, p = .03). Poorer verbal memory performance was associated with an increased risk of noncompletion of CR among participants with coronary artery disease. Further studies exploring practical methods for screening and targeted support might improve rehabilitation outcomes.Psychosomatic Medicine 08/2011; 73(7):580-7. · 3.97 Impact Factor -
Article: Cardiopulmonary fitness is associated with cognitive performance in patients with coronary artery disease.
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ABSTRACT: To investigate the association between cardiopulmonary fitness and cognitive performance in subjects with coronary artery disease (CAD). Cross-sectional observational study. Outpatient cardiac rehabilitation. Eighty-one subjects with CAD. Cardiopulmonary fitness was assessed by measuring peak oxygen uptake (VO(2Peak) ) in a standardized exercise stress test. The fraction of the predicted age and sex norm for VO(2Peak) was computed for each patient. A battery of neuropsychological tests including the Stroop, Trail-Making Test Part B, Digit Symbol Coding, Revised Brief Visuospatial Memory Test, California Verbal Learning Test 2nd Edition, and Mini Mental State Examination (MMSE) was administered, from which composite Z-scores were computed for tasks involving executive function and memory. Executive function, memory, and MMSE scores were correlated with VO(2Peak) , but only performance in the executive domain was independently associated with VO(2Peak) in multiple linear regression. In a multiple linear regression model controlling for potential clinical confounders, VO(2Peak) (β=.666, P<.001) and covariates accounted for 36% of the variance in executive function scores. Poorer VO(2Peak) is associated with poorer cognition, particularly executive function, in subjects with CAD independent of other cardiac risk factors. Cardiopulmonary fitness may be a protective factor for cognition in patients with CAD.Journal of the American Geriatrics Society 08/2010; 58(8):1519-25. · 3.74 Impact Factor -
Article: Traumatic brain injury, Apolipoprotein E-epsilon4, and cognition in older adults: a two-year longitudinal study.
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ABSTRACT: Patients with mild-to-moderate traumatic brain injury (TBI) (N=69) were compared with age-, gender-, and education-matched healthy control group subjects (N=79) on performance of neuropsychological tests at one and 2 years following injury, and informant-rated functional abilities. All subjects were assessed for the presence of the Apolipoprotein E-epsilon4 (APOE-epsilon4) allele and rated for "mild cognitive impairment" (MCI) or dementia. Traumatic brain injury patients were no different from the comparison group on measures of cognition or functional impairment. Traumatic brain injury was not associated with higher rates of amnestic mild cognitive impairment or dementia, and APOE-epsilon4 was not associated with cognition.Journal of Neuropsychiatry 02/2008; 20(1):68-73. · 2.51 Impact Factor -
Article: The utility of the mini-mental status exam in older adults with traumatic brain injury.
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ABSTRACT: To assess the utility of the Mini-Mental Status Examination (MMSE) among the older TBI population. The MMSE and a number of other neuropsychological tests were administered to forty-three adults aged 50 and over one year following mild to moderate TBI. The sensitivity, specificity, and predictive value of the MMSE were evaluated in relation to these tests. The domains of the MMSE generally exhibited low sensitivity while high specificity was demonstrated by Attention and Language. Positive predictive value was high only for Language but negative predictive value was moderate to high for all domains. These results suggest that one year following mild to moderate TBI among older adults, the MMSE should not be used to identify those with cognitive impairment; if administered, a perfect score on a component of the MMSE suggests that enhanced testing in that given domain may not reveal further impairment. A small sample size and a small number of those impaired limit our results.Brain Injury 01/2007; 20(13-14):1377-82. · 1.36 Impact Factor -
Article: Outcome after traumatic brain injury sustained in older adulthood: a one-year longitudinal study.
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ABSTRACT: The objective of this study was to explore the effects of traumatic brain injury (TBI) on cognition and functioning in older adults in a one-year longitudinal study. Participants with mild-to-moderate TBI were compared with an age-, gender-, and education-matched healthy comparison group on aspects of cognition. Neuropsychologic tests were administered at one year. Self-reported measures of functioning were completed at baseline, six months, and one year. Informants rated instrumental functioning at one year. Sixty-nine subjects aged 50 years and over (mean: 67 years; standard deviation: 7.9) and a comparison group of 79 participants were assessed. Patients with TBI had poorer processing speed, verbal memory, language, and executive function; they self-reported more psychologic distress, psychosocial dysfunction, and postconcussive symptoms; and they were rated as more impaired in functioning than the comparison group. TBI of moderate severity accounted for most of the between-group differences. TBI, particularly of moderate severity, led to poorer cognitive and psychosocial functioning one year postinjury among older adults. The clinical significance of this may become more evident with time in this vulnerable population.American Journal of Geriatric Psychiatry 06/2006; 14(5):456-65. · 3.64 Impact Factor -
Article: Cognitive impairment associated with major depression following mild and moderate traumatic brain injury.
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ABSTRACT: Traumatic brain injury (TBI) and major depression are neuropsychiatric conditions that have been associated with cognitive dysfunction. The aim of this study was to explore the relationship between major depression and cognitive impairment following mild and moderate TBI. Seventy-four TBI patients were assessed for the presence of major depression using the Structured Clinical Interview for the DSM-IV and completed a neurocognitive assessment battery. Subjects with major depression (28.4%), compared to those without, were found to have significantly lower scores on measures of working memory, processing speed, verbal memory and executive function. Potential mechanisms and implications for treatment are discussed.Journal of Neuropsychiatry 02/2005; 17(1):61-5. · 2.51 Impact Factor -
Article: The effects of normal aging on humor appreciation.
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ABSTRACT: The importance of humor in healthy aging is being recognized. We compared elderly and young participants on their comprehension and appreciation of, and reaction to, verbal and nonverbal humor tests. Cognitive processes-working memory, cognitive flexibility, verbal abstraction, and visual scanning-were studied in relation to humor. Results indicated a relative deficit in the elderly in the cognitive comprehension of humor-selecting punch lines to jokes and in a cartoon array test. Measures of cognitive function correlated with humor comprehension. In contrast to this deficit in comprehension, the elderly showed intact affective appreciation and emotional reactiveness. Because of the hypothesis of frontal lobe degeneration as a basis for changes with aging, we compared the elderly to patients with focal frontal lesions. In this comparison, the elderly were significantly better than the patients in their comprehension of humor. They also displayed intact appreciation of humor compared to patients with frontal lesions. This preliminary study suggests that preserved affective responsiveness may underlie the success in using humor as a coping mechanism in the elderly.Journal of the International Neuropsychological Society 10/2003; 9(6):855-63. · 2.76 Impact Factor -
Article: The effects of normal aging on humor appreciation
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ABSTRACT: The importance of humor in healthy aging is being recognized. We compared elderly and young participants on their comprehension and appreciation of, and reaction to, verbal and nonverbal humor tests. Cognitive processes—working memory, cognitive flexibility, verbal abstraction, and visual scanning—were studied in relation to humor. Results indicated a relative deficit in the elderly in the cognitive comprehension of humor—selecting punch lines to jokes and in a cartoon array test. Measures of cognitive function correlated with humor comprehension. In contrast to this deficit in comprehension, the elderly showed intact affective appreciation and emotional reactiveness. Because of the hypothesis of frontal lobe degeneration as a basis for changes with aging, we compared the elderly to patients with focal frontal lesions. In this comparison, the elderly were significantly better than the patients in their comprehension of humor. They also displayed intact appreciation of humor compared to patients with frontal lesions. This preliminary study suggests that preserved affective responsiveness may underlie the success in using humor as a coping mechanism in the elderly. (JINS, 2003, 9, 855–863.)Journal of the International Neuropsychological Society 08/2003; 9(06):855 - 863. · 2.76 Impact Factor
Top co-authors
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Institutions
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2003–2013
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University of Toronto
- • Department of Psychiatry
- • Sunnybrook Health Sciences Centre
- • Department of Psychology
Toronto, Ontario, Canada
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2008–2011
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Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
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