Although the relationship between aging and cognitive decline is well established, there is substantial individual variability in the degree of cognitive decline in older adults. The present study investigates whether variability in cognitive performance in community-dwelling older adults is related to the presence of whole brain or tract-specific changes in white matter microstructure. Specifically, we examine whether age-related decline in performance on the Montreal Cognitive Assessment (MoCA), a cognitive screening tool, is mediated by the white matter microstructural decline. We also examine if this relationship is driven by the presence of cardiovascular risk factors or variability in cerebral arterial pulsatility, an index of cardiovascular risk. Sixty-nine participants (aged 43-87) completed behavioral and MRI testing including T1 structural, T2-weighted FLAIR, and diffusion-weighted imaging (DWI) sequences. Measures of white matter microstructure were calculated using diffusion tensor imaging analyses on the DWI sequence. Multiple linear regression revealed that MoCA scores were predicted by radial diffusivity (RaD) of white matter beyond age or other cerebral measures. While increasing age and arterial pulsatility were associated with increasing RaD, these factors did not mediate the relationship between total white matter RaD and MoCA. Further, the relationship between MoCA and RaD was specific to participants who reported at least one cardiovascular risk factor. These findings highlight the importance of cardiovascular risk factors in the presentation of cognitive decline in old age. Further work is needed to establish whether medical or lifestyle management of these risk factors can prevent or reverse cognitive decline in old age.

ObjectivesThis study aimed to describe the experiences and challenges faced by adolescents with moderate and severe congenital heart defects (CHD) or Chronic Rheumatic Heart Disease (CRHD) and to determine their needs in order to develop an Adolescent Transition Psychoeducational Program.MethodsThe study involved seven adolescents with moderate to severe CHD/CRHD, six parents, and four health care providers in Institute Jantung Negara (National Heart Institute). Participants were invited for a semi-structured interview. Qualitative data were analyzed through the Atlas.ti 7 program using triangulation methods.Results/conclusionsWe identified five themes concerning the experience and challenges of adolescents relating to: (1) emotional/psychological issues; (2) the progress of the illness; (3) relationship issues; (4) future preparation; and, (5) school and community. These themes were identified together with eleven subcategories. The staff expressed support for the development of the Adolescent Transition Psychoeducational Program and adolescents with CHD/CRHD and their parents were willing to participate in the program if their schedule allowed. Their suggestions to improve the program were classified into six categories, with two main themes, (1) the self-management of illness in life and the future; and, (2) social support. In conclusion, the findings from the situation analysis act as a basis for a conceptual framework that will contribute to the development of an Adolescent Transition Psychoeducational Program that aims to empower adolescents with CHD/CRHD, enabling them to manage challenges during the transition phase between childhood and adulthood.

Objectives:The present study aims to develop and test the effectiveness of a “HeartBEAT” Adolescent Transition Psychoeducation Program (ATPP) in facilitating the well-being of adolescents who have been diagnosed with congenital heart defects (CHD).Methods:The HeartBEAT ATPP was developed after reviewing existing transition interventions and determining adolescents’ needs. It was based upon two theories, namely the Shared Management Model and Antonovsky’s Salutogenic Model and included five aspects: (i) knowledge on illness and treatments, (ii) self-management and transition skills, (iii) purpose of life, (iv) social support, and (v) emotional regulation skills. Mixed-methods pilot testing was then conducted. Paired t-test was used to explore the effectiveness and qualitative interviews were also conducted.Results/Conclusions:Fourteen patients aged 16–19 enrolled in this study, but only eight patients successfully complete the programme. Results showed that a paired t-test was conducted to determine its effectiveness. Results showed that the programme had significantly increased self-management knowledge (t (7) = −6.328, p < 0.05) and affectionate support (t (7) = −1.029, p < 0.05). Qualitative findings also showed that all patients were able to share emotional regulation and identify their purpose of life after the programme. However, there was no significant increase in their self-management skills. In summary, the “HeartBEAT” ATPP has demonstrated efficacy in enhancing self-management knowledge, affectionate support, identifying the patients’ life plan, and enhancing the emotional regulation skills of the adolescents with CHD.