Family caregivers of patients enrolled in home-based palliative care programmes provide unpaid care and assistance with daily activities to terminally ill family members. Caregivers often experience caregiver burden, which is an important predictor of anxiety and depression that can extend into bereavement. We conducted a longitudinal, prospective cohort study to comprehensively assess modifiable and non-modifiable patient and caregiver factors that account for caregiver burden over the palliative care trajectory. Caregivers (n = 327) of patients with malignant neoplasm were recruited from two dedicated home-based palliative care programmes in Southern Ontario, Canada from 1 July 2010 to 31 August 2012. Data were obtained from bi-weekly telephone interviews with caregivers from study admission until death, and from palliative care programme and home-care agency databases. Information collected comprised patient and caregiver demographics, utilisation of privately and publicly financed resources, patient clinical status and caregiver burden. The average age of the caregivers was 59.0 years (SD: 13.2), and almost 70% were female. Caregiver burden increased over time in a non-linear fashion from study admission to patient death. Increased monthly unpaid care-giving time costs, monthly public personal support worker costs, emergency department visits and low patient functional status were associated with higher caregiver burden. Greater use of hospice care was associated with lower burden. Female caregivers tended to report more burden compared to men as death approached, and burden was higher when patients were male. Low patient functional status was the strongest predictor of burden. Understanding the influence of modifiable and non-modifiable factors on the experience of burden over the palliative trajectory is essential for the development and targeting of programmes and policies to support family caregivers and reduce burden. Supporting caregivers can have benefits such as improved caregiver health outcomes, and enhancing their ability to meet care-giving demands, thereby potentially allowing for longer patient care in the home setting.

Objectives Individuals with subjective memory complaints and symptoms of depression and/or anxiety are at high risk for further cognitive decline, and possible progression to dementia. Low-burden interventions to help slow or prevent cognitive decline in this high-risk group are needed. The objective of this study is to assess the feasibility of combining Mindfulness-Based Stress Reduction (MBSR) with transcranial direct current stimulation (tDCS) to increase putative benefits of MBSR for cognitive function and everyday mindfulness in depressed or anxious older adults with subjective cognitive decline. Methods We conducted a two-site pilot double-blind randomized sham-controlled trial, combining active MBSR with either active or sham tDCS. The intervention included weekly in-class group sessions at the local university hospital and daily at-home practice. Anodal tDCS was applied for 30 min during MBSR meditative practice, both in-class and at-home. Results Twenty-six individuals with subjective cognitive complaints and symptoms of depression and/or anxiety were randomized to active ( n = 12) or sham tDCS ( n = 14). The combination of MBSR and tDCS was safe and well tolerated, though at-home adherence and in-class attendance were variable. While they were not statistically significant, the largest effect sizes for active vs. sham tDCS were for everyday mindfulness ( d = 0.6) and social functioning ( d = 0.9) ( F (1,21) = 3.68, p = 0.07 and F (1,21) = 3.9, p = 0.06, respectively). Conclusions Our findings suggest that it is feasible and safe to combine tDCS with MBSR in older depressed and anxious adults, including during remote, at-home use. Furthermore, tDCS may enhance MBSR via transferring its meditative learning and practice into increases in everyday mindfulness. Future studies need to improve adherence to MBSR with tDCS. Trial Registration ClinicalTrials.gov (NCT03653351 and NCT03680664). Supplementary Information The online version contains supplementary material available at 10.1007/s12671-021-01764-9.

Abstract Anticholinergic burden (ACB) from medications impairs cognition in schizophrenia. Cognition is a predictor of functional capacity; however, little is known about ACB effect on functional capacity in this population. This study assesses the relationship between ACB and functional capacity across the life span in individuals with schizophrenia after controlling for ACB effect on cognition. A cross-sectional analysis was performed with data collected from 6 academic tertiary health centers. Two hundred and twenty-three community-dwelling participants with schizophrenia or schizoaffective disorder were included in this study. Main variables were ACB, antipsychotic olanzapine equivalents, functional capacity, cognition, and negative symptoms. Simultaneous linear regression analyses were performed to assess the association between ACB, functional capacity, and cognition and then between ACB and cognition. A mediation analysis was then performed to examine whether cognition mediated ACB effect on functional capacity if there was an association between ACB and cognition. Mean age of participants was 49.0 years (SD = 13.1, range 19–79), and 63.7% of participants had severe ACB, ie, a total score of 3 or above. Regression analyses revealed that ACB, age, education, and cognition independently predicted functional capacity and that ACB predicted cognition among those aged 55 years and older. Mediation analysis showed that cognition did partially mediate the effect of ACB on functional capacity in this older cohort. In conclusion, people with schizophrenia are exposed to severe ACB that can have a direct negative impact on functional capacity after controlling for its impact on cognition. Reducing ACB could improve functional capacity and potentially real-world function in schizophrenia.

3,5 and on behalf of the PACt-MD Study Group Ordering of information is a critical component that underlies several cognitive functions. Prefrontal theta-gamma coupling (TGC) is a neurophysiologic measure associated with ordering of information during the performance of a working memory task (N-back).Little is known about the relationship between TGC and ordering during other cognitive tasks or whether the relationship between TGC and ordering of information is independent of clinical condition. This study aimed to determine whether the relationship between TGC and ordering of information exists independent of a task and its timing, and whether this relationship is the same in different clinical conditions. A total of 311 participants were assessed using a neuropsychological battery that included the N-back during which TGC was measured; two other tasks that also require ordering; and three tests that do not require ordering. All non-Nback tasks were completed several days separate from the N-back by a mean interval (SD) of 5.14 (8.03). Our three hypotheses were that TGC during the N-back task would be associated with performance on N-Back and other cognitive tasks that also require ordering, but not with performance on cognitive tasks that do not require ordering; and that these relationships will be independent of clinical diagnosis. Multivariate linear regression results show that TGC was associated with performance on the ordering tasks but not the non-ordering tasks. In addition, there was no interaction between TGC and diagnosis. Our study is the first to demonstrate that TGC is a neurophysiologic measure of ordering information across several cognitive tasks that require ordering, and this TGC-ordering relationship is stable over time even when several days separate the measurement of TGC and the performance of the ordering tasks. Our results also show that this relationship is independent of clinical diagnosis, supporting the brain-behavior nature of this relationship. These results highlight the importance of TGC in ordering-based cognition, and suggest that TGC could be a valid target for interventions that aim to enhance this function across cognitive tasks and clinical conditions.