Faculty Bibliography

OBJECTIVES/OBJECTIVE:This study examined whether cognitive function influenced the benefits of multicomponent team interventions designed to improve quality of life. DESIGN/METHODS:Data from 2 multisite randomized trials of multicomponent interventions were pooled. The interventions involved symptom management by a nurse, psychosocial counseling by a social worker, and collaboration among palliative care, primary care, and specialists. SETTING AND PARTICIPANTS/METHODS:Patients with chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and heart failure (HF) enrolled in 2 multisite randomized trials. METHODS:Cognitive function was assessed using the Telephone Interview for Cognitive Status (TICS) and analyzed continuously and dichotomously (<36 on TICS indicating cognitive dysfunction). Mixed-effects linear regression models assessed whether cognitive function modified the effect of the interventions on quality of life and related outcomes. We also explored whether cognitive function was associated with the number of intervention visits, intervention staff time, and completed study team recommendations (consults, tests, behavior changes). RESULTS:A total of 610 participants across both trials had a mean age of 67 years, nearly all had HF or COPD, and a small proportion had ILD; 83% of participants screened positive for cognitive dysfunction. Cognitive function did not influence the benefits of the interventions across outcomes (P > .10). In exploratory analyses, lower TICS scores were associated with fewer completed intervention visits (P = .007). Total staff time, consults, tests, and behavior change recommendations were similar across TICS scores. CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Cognitive dysfunction is prevalent among patients with chronic cardiopulmonary illnesses. Intervention benefits were not affected by cognitive status. Exploratory analyses found an association between worse cognitive function and fewer intervention visits but no difference in intervention time, tests, or behavior change recommendations. Increased effort to identify cognitive dysfunction in this population and engage them in interventions to improve quality of life should be considered.

BACKGROUND:Rapid eye movement sleep behavior disorder occurs with idiopathic Parkinson's disease (PD) and often precedes PD. Its frequency in LRRK2-PD and utility as a preclinical marker has not been established. METHODS:One hundred forty-four idiopathic PD, 142 LRRK2 G2019S mutation PD, 117 non-manifesting carriers, 93 related noncarriers, and 40 healthy controls completed the Rapid eye movement sleep Behavior Disorder Screening Questionnaire. RESULTS:Cut scores were met by 30.6% idiopathic PD, 19.7% LRRK2-PD, 6% nonmanifesting carriers, 20.4% related noncarriers, and 15% controls. The likelihood of abnormal scores was decreased in LRRK2-PD versus idiopathic PD (odds ratio = 0.55, P = 0.03), nonmanifesting carriers versus related noncarriers (OR = 0.25, P < 0.01), and PD of less than 3 years' duration, 1 of 19 LRRK2-PD versus 14 of 41 idiopathic PD (P < 0.05). CONCLUSIONS:A lower frequency of abnormal questionnaire scores is seen in LRRK2-PD, especially in early LRRK2-PD, and in nonmanifesting carriers. Therefore, the Rapid eye movement sleep Behavior Disorder Questionnaire is unlikely to serve as a preclinical marker for phenoconversion to PD.