In the course of Time spasms near kidney flavoxate 200mg without a prescription, these Extensive maps were found somewhat wanting muscle relaxer 800 mg trusted 200 mg flavoxate, and so the College of Cartographers evolved a Map of the Empire that was of the same Scale as the Empire and that coincided with it point for point muscle relaxant 2632 order 200 mg flavoxate amex. Cultural Studies is a book at least twice to three times as long as the average academic book spasms synonym discount 200 mg flavoxate mastercard. This monstrous work, excessively mapping the terrain of cultural studies, is sourced in the United States. In reviewing the book, Fredric Jameson has summed up the nationalities of those included in the book: `there are 25 Americans, 11 British, 4 Australians, 2 Canadians, and one Hungarian and Italian, respectively. The international dissemination of cultural studies can be compared with that of one of its predecessors: sociology. As a modern discipline, sociology has always presented itself as a universal body of knowledge. Driven by a functionalist problematic, this discourse accords a space for internal differences-for example, of class, gender and race-only in terms of (the problems of) inclusion and integration rather than in terms of the radicalization of difference. However, all these national particulars can be specified and described in terms of the presumably universal concepts and theories of a presumably generally-applicable sociological master narrative. In the universalizing ambitions displayed by the publication of a book like Cultural Studies, there is the danger that cultural studies could become another modern discipline after all. In contrast, McRobbie and Bennett, as we saw at the beginning of this article, are arguing for a cultural studies which is always provisional, that is, not pre-determined by a universal paradigm. For example, Nelson, Treichler and Grossberg write that `[d]ifferent traditions of cultural studies, including British and American versions, have grown out of efforts to understand the processes that have shaped modern and postwar society and culture. However, while this insistence on pluralism predicated on the national is strategically useful as a bulwark against creeping universalism, it also has some problems. As we have already suggested, sociology privileges the universal over national particularities, which are reduced to being versions of the universal concept of the nation-state. Some in cultural studies now seem to want to turn things around: as any tendency towards universalism is now virtually declared a taboo, it is the individual nation-state which is now earmarked as the privileged site of particularity. What we have here is a straightforward inversion of the hierarchies of modern sociology. How then can we effectively develop an internationalism in cultural studies that is more than an interchange between already-constituted national constituents? The first two took place in Australia, while the third- arguably the most subversive of the three-was organized by Kuan-Hsing Chen in Taiwan. To date, the Taiwanese conference has proved to be so left-field in the cultural studies project, that its place in the official history of the field remains uncertain. As Ien Ang wrote in her introduction to the conference proceedings, published in the journal Cultural Studies14: `What is needed (. It is clear, then, that it is no longer possible for a knowledge formation to unproblematically universalize itself without meeting any resistance from those at whose expense this universalizing process is carried out. However, what is at issue is not just a question of prioritizing the particular over the universal. Just as any invocation of the universal is never innocent, any assertion of particularity also cannot go unquestioned. As we said before, there are problems with uncritically adopting the national as the privileged site of the particular, as it runs the risk of hypostatizing differences into static, mutually exclusive categories. In other words, what cultural studies needs to do if it wants to avoid universalization is not just valorize any asserted particularity, but reflect on the concrete processes of particularization itself, and to interrogate its politics. The adoption of the category of the postcolonial as a term of self-description by Australians and Canadians is one such strategy of particularization which has the possibility of problematizing both the universal and the national-and we will have more to say about its politics (good and bad) later. In a more general sense, the construction of positions of particularity is a necessary condition for engendering the contested localized knowledges Hall talks about. This is one reason why Stuart Hall was one of the star speakers at the Illinois conference. The received history of cultural studies claims that it originated in Britain in the late 1950s. Its founding fathers were Richard Hoggart, Raymond Williams and, though himself young enough to be a son, Stuart Hall. It is interesting to dwell on this myth of origin, if only briefly, as it sheds some light on some of the contradictions in the whole self-understanding of cultural studies. After all, the discipline of sociology also has three founding fathers: Marx, Weber and Durkheim. The same is the case with English literary studies, the other major disciplinary predecessor of British cultural studies: its three founding fathers were Arnold, Richards and Leavis. The problem with such a mythic history is that it makes it difficult for us to construct a more pluralistic de-centred account of the emergence of cultural studies in different parts of the world. Yet another, also less explicitly personal, history is provided by Lawrence Grossberg in his `The formations of cultural studies: An American in Birmingham. Cultural studies, he says, did not `emerge somewhere at the moment when I first met Raymond Williams, or in the glance I exchanged with Richard Hoggart. At the same time, as far as we know, he has never concerned himself with explaining why British cultural studies could have met with such a positive reception outside Britain as well (and of course there is no intrinsic reason why he should have). In his earlier work especially, Hall has tended not to be concerned with the transnational dimensions of cultural studies practice; Britain formed both the naturalized boundary and the given context for this practice. In this respect, it is significant that Hall has tended to paint the historical emergence of cultural studies in Britain as an organically British development, a development determined by internal national forces. An attempt to address the manifest break-up of traditional culture, especially traditional class cultures, it set about registering the impact of the new forms of affluence and consumer society on the very hierarchical and pyramidal structure of British society. Trying to come to terms with the fluidity and the undermining impact of the mass media and of an emerging mass society on this old European class society, it registered the cultural impact of the long-delayed entry of the United Kingdom into the modern world. The result of this accommodation was that: [the industrial bourgeoisie] never generated a revolutionary ideology, like that of the Enlightenment. They developed powerful sectoral disciplines-notably the economics of Ricardo and Malthus. But they failed to create any general theory of society, or any philosophical synthesis of compelling dimensions. In a LukŠ±csian move Anderson argues that the notion of totality, what we have described as the central universalizing concept of modern disciplines, is a typifying feature of bourgeois ideology; of a bourgeoisie struggling to legitimate its position of power. Where Anderson argued that the nineteenth-century bourgeoisie was assimilated into the feudal British tradition, Hall describes the post-Second World War period as the moment when the neo-feudal structure of British society was finally destabilized. According to Anderson, literary criticism was a means of preserving the hegemonic collusion of the old (feudal) and the new (bourgeois) dominant classes. It did not originate in the old hegemonic order but came out of the very unsettling of that order, and articulated its project as both trying to understand the new socio-cultural order and critiquing the power relations, particularly those related to class, which pervaded the old order. Cultural studies, then, in this historical account, is understood as being the product of a very idiosyncratic British historical and cultural conjuncture. What we are presented with here is a uniquely British history for the emergence of cultural studies. However, the historical conditions outlined by Hall as determining this emergence-for example, the growth of the mass media and consumer society-are by no means uniquely British, but have, as we all know, fundamentally transnational dimensions and repercussions. And more often than not it is precisely in terms of such a quasi-colonialist expansion that historical accounts of the internationalization of cultural studies have been cast. It is such a construction which makes it tempting, from a British vantagepoint at least, to experience the rapid international success of cultural studies in terms of a dilution of the pure original. This is particularly the case in British responses to the American appropriation of cultural studies. His severe objections against American cultural studies, so politely worded here, are worth exploring further, but this is not the place to do so. Suffice it to say here that this text signals an immense cultural gap between American and British (and more generally, non-American) academic scholarship and critical intellectualism. What interests us at this point is the speaking position from which Hall articulates and constructs what he sees as the major contrast between American and British cultural studies. In recalling what the Centre was up to , Hall said to his American audience, with a fine sense of irony: there is no doubt in my mind that we were trying to find an institutional practice in cultural studies that might produce organic intellectuals. We were organic intellectuals without any organic point of reference; organic intellectuals with a nostalgia or will or hope (. And one has to say that this sentiment has been voiced by more than one early Birmingham inhabitant. We never connected with that rising historic movement; it was a metaphoric exercise. However, because this criticism is cast in terms of a departure from what was current at the Birmingham Centre, the danger exists that the latter is over-romanticized.
In these situations muscle relaxant renal failure generic flavoxate 200 mg online, it will also be important to assess whether the threshold for effectiveness is the same for both outcomes muscle relaxant drugs over the counter order 200mg flavoxate mastercard. It is possible that there may be a threshold effect or curvilinear effect for the intervention esophageal spasms xanax generic flavoxate 200mg fast delivery. Diagnosis during life is based on the clinical phenotype of symptom progression muscle relaxant pregnancy category generic 200mg flavoxate overnight delivery, which is heterogeneous between individuals. But these findings need to be interpreted in the context of the effect size of a treatment or intervention that would make a noticeable difference in the disease burden. Thus, the ideal interventions should be multi-dimensional, combining interventions for multiple risk factors and controlling for many other factors. Among those that are not appropriate for intervention trials are exposures that one would want to avoid due to their negative impact on outcomes other than cognition. For example, smoking, diabetes, hypertension, and few years of education are all factors that have deleterious effects on health and lifestyle. Although healthcare interventions may be appropriate for some other potential influential factors. Public education campaigns to change behavior to incorporate or exclude these factors would have relatively less risk (cost) to individuals. One of the key limiting factors in synthesizing the current literature is the lack of standardization of exposure and outcome measures. Because outcome measures for cognitive decline were not standardized across studies, we limited the use of studies with continuous outcome measures when the conclusions from these studies were consistent with those from studies with categorical outcome measures. This meant that some studies reporting continuous measures were not reported in detail in this report, and the results of these studies were not synthesized quantitatively, but we do not think that this changed the conclusions for any exposure factor. In the future, more standardization at various steps of the research process is needed before all available data can be synthesized. We also acknowledge that standardization 303 can have its weaknesses and can limit innovations that may advance science. The key is to strike a balance between enough uniformity to maximize the use of study results and methods that are novel enough to advance the field to the next level. The latter finding may be explained by the weight loss often associated with the disease itself. Ideally the exposure should be measured in different age groups within the same study to control for inter-study variability in measurement, but this may not be realistic given the long period of followup necessary when studying exposures in mid-life. Although one might assume that interventions or lifestyle modification should be undertaken as early as possible, there may be other windows during which a given intervention may exert its effect. To evaluate the potential impact of excluding small studies, we coded detailed reasons for exclusion in a subset of citations. Of 549 citations, only three observational studies and two randomized controlled trials were excluded solely for small sample size. Applying these rates to the 6713 citations identified overall from electronic searching, we may have excluded as many as 48 articles for small sample size that otherwise would have met our eligibility criteria. For factors where we have large studies already, it is very unlikely that the addition of small studies would change the estimate of effect or conclusions. Given the variability in outcome measures and the limited resources and time to complete the present project, it was not possible to perform quantitative meta-analyses on studies with continuous outcomes. We acknowledge, however, that quantitative estimates of effect may have been easier to interpret than qualitative syntheses. These exposures are of potential interest, but were not specified by the planning committee. We note that this is a difficult literature to search for several reasons, including the wide range of factors assessed, the lack of well-validated search strategies for relevant observational studies, variability in categorizing studies by standard search terms, and variability in the terms used to categorize cognitive decline. These studies do not typically design their analyses specific to one or two factors of interest. We were not able to assess systematically how this approach may influence the association between the factor of interest and the outcome, but we note the issue as one to be considered when interpreting the results. These leads now need to be pursued with potentially novel approaches and increasingly rigorous scientific methods to be able to identify a real signal among the numerous factors throughout the life course that may contribute to the complex late-life disorders considered in this report. Effects of interventions in important subgroups, such as minority populations, were evaluated infrequently. Moreover, several of the factors reviewed have demonstrated benefits beyond the potential of preserved cognition; that is, they promote overall health. The most general conclusions of this evidence report are summarized in Tables 74 and 75. For each factor examined, we considered the entire body of evidence and summarized the quality of that evidence as low, moderate, or high. These initial ratings may be modified by considerations relating to: detailed study design, consistency, strength of association, dose-response effect, directness, precision, and consideration of all plausible residual confounders that could reduce a demonstrated effect. Note that even within a given rating level, the quality of evidence may vary substantially; for example, there is considerable variability within the "low" quality level. The tables also list factors for which the evidence was insufficient to establish whether or not an association exists. It is noteworthy that this last category includes many of the risk factors examined in this report. In addition to sparse evidence, the extant research literature has other important limitations. Needed advances in study design and reporting include validated measures of exposure, prespecified exposure categorizations, longer term trials, reporting of power calculations, and an agreed-upon battery of cognitive measures. Improving research design and reporting in these and other ways could improve confidence in observed associations and targeting of potential interventions. Well-designed, long-term cohort studies with robust measures of exposure and cognitive outcomes are needed to address the factors for which there is a strong biological mechanism or preliminary clinical evidence to suggest an important association. Prevalence of dementia in the United States: the aging, demographics, and memory study. International statistical classification of diseases and related health problems, Tenth Edition. Chapter V, categories F00-F99, Mental behavioural and developmental disorders, clinical description and diagnostic guidelines. The relationship between a dementia diagnosis, chronic illness, medicare expenditures, and hospital use. Mortality with dementia: results from a French prospective community-based cohort. Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Informal costs of dementia care: estimates from the National Longitudinal Caregiver Study. Journals of Gerontology Series B-Psychological Sciences & Social Sciences 2001;56(4):S219-28. Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews, Version 1. Fish consumption, long-chain omega-3 fatty acids and risk of cognitive decline or Alzheimer disease: a complex association. The efficacy of omega-3 fatty acids on cognitive function in aging and dementia: a systematic review. Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia (Review). Raloxifene hydrochloride, a selective estrogen receptor modulator: safety assessment of effects on cognitive function and mood in postmenopausal women. Cholesterol as a risk factor for dementia and cognitive decline: a systematic review of prospective studies with metaanalysis. Diabetes and the risk of multi-system aging phenotypes: a systematic review and meta-analysis. Cognitive decline and dementia in diabetes-systematic overview of prospective observational studies. Cholinesterase inhibitors in mild cognitive impairment: a systematic review of randomised trials. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis. Obesity and central obesity as risk factors for incident dementia and its subtypes: a systematic review and metaanalysis. Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment.
Be specific to ensure that the student with Asperger Syndrome knows why the teacher is providing praise muscle relaxant 2265 200 mg flavoxate with mastercard. I think an effective successful inclusive classroom spasms foot 200 mg flavoxate overnight delivery, and their way to do that is to provide the student student(s) with Asperger Syndrome will be with ongoing positive input muscle relaxers to treat addiction generic 200 mg flavoxate with visa. In addition case spasms down left leg cheap 200 mg flavoxate overnight delivery, even just a little bit of praise from to these methods, it is also essential to a teacher goes a long way. Children with with Asperger Syndrome Asperger Syndrome generally respond well to teachers who are patient and compassionate, flexible in their teaching styles, and speak in a calm, quiet manner. Whenever possible, students with Asperger Syndrome should be placed in this type of classroom environment. After that, it is critical to establish mutually agreed-upon modes and patterns of communication with the family throughout the school year. Your first conversations with the family should focus on the individual characteristics of the student, identifying strengths and areas of challenge. The family may have suggestions for practical accommodations that can be made in the classroom to help the child function at his or her highest potential. In these conversations, it is critical to establish a tone of mutual respect while maintaining realistic expectations for the course of the year. While the information you exchange may often focus on current classroom - Mother of a 12-year-old diagnosed with Asperger challenges, strategies employed, and ideas for Syndrome alternative solutions, do not forget to include positive feedback on accomplishments and milestones reached. Families could respond with their perspective on the problem and their suggestions for solutions. Families can also support you from home in your social and behavioral goals for your student with Asperger Syndrome. Open, ongoing communication with families of students with Asperger Syndrome creates a powerful alliance. Be aware that some families may have had negative experiences with other schools or teachers in the past. Appendix C, on page 45, contains a worksheet with suggested questions to ask during your initial meetings with the parents. The education of and ways you can place children with teachers and staff is paramount. Teachers and behaviors, sensitivities, and other staff need to have the training it takes to characteristics of your individual recognize the deficits and traits of the spectrum in student with Asperger Syndrome. There is no doubt that children with Asperger Syndrome have social deficits that make it more difficult for them to establish friendships than typically developing children. However, with appropriate assistance, children with Asperger Syndrome can engage with peers and establish mutually enjoyable and lasting relationships. It is critical that teachers of children with Asperger Syndrome believe this to be true and expect students with Asperger Syndrome to make and maintain meaningful relationships with the adults and other children in the classroom. While teasing may be a common occurrence in the everyday school experience for young people, children with Asperger Syndrome often cannot discriminate between playful versus mean-spirited teasing. Educators and parents can help children with Asperger Syndrome recognize the difference and respond appropriately. In this way, the student with Asperger Syndrome would have a friend to listen to them and to report any potential conflicts with other students. Also, educators should routinely check in with the student with Asperger Syndrome and/or the parents to ensure the comfort of the student in the classroom. In addition to the "buddy" strategy described above, it may also be important to educate typically developing students about the common traits and behaviors of children with Asperger Syndrome. The characteristics of Asperger Syndrome can cause peers to perceive a child with the disorder as odd or different, which can lead to situations that involve teasing or bullying. Research shows that typically developing peers have more positive attitudes, increased understanding, and greater acceptance of children with Asperger Syndrome when provided with clear, accurate, and straightforward information about the disorder. When educated about Asperger Syndrome and specific strategies for how to effectively interact with children with Asperger Syndrome, more frequent and positive social interactions are likely to result. Many of the social interactions occur outside the classroom in the cafeteria and on the playground. Without prior planning "Since social interaction is the largest deficit and extra help, students with Asperger for children with Asperger Syndrome, a Syndrome may end up sitting by supportive classroom environment is essential themselves during these unstructured so that they do not shut down and isolate times. To provide such a supportive you may consider a rotating assignment classroom, everyone involved should be of playground peer buddies for the educated about Asperger Syndrome, even the student with Asperger Syndrome. The academic and social success of young people with Asperger Syndrome can be greatly enhanced when the classroom environment supports their unique challenges. Peer education interventions, such as those listed in the Resources section of this guide, can be used with little training and have been shown to improve outcomes for both typically developing peers and young people with developmental disorders, such as autism and Asperger Syndrome. Specific strategies that can be used to support social interactions for students with Asperger Syndrome are described in Appendix D, page 51. Step 5: Collaborate on the Educational Program Development the next key step in your preparations will be to participate in the development and implementation of an educational program for your student with Asperger Syndrome. Because the challenges associated with Asperger Syndrome affect many key aspects of development, the impact of the disorder on education and learning is profound. The parent has to become an advocate for the child and make sure the plan is implemented or changed if the original ideas are not working for the child. The school psychologist, social worker, classroom teacher, and/or speech pathologist are examples of educational professionals who conduct educational assessments. A neurologist may conduct a medical evaluation, and an audiologist may complete hearing tests. The classroom teacher also gives input about the academic progress and classroom behavior of the student. Annual goals must explain measurable behaviors so that it is clear what progress should have been made by the end of the year. The short-term objectives should contain incremental and sequential steps toward meeting each annual goal. Annual goals and short-term objectives can be about developing social and communication skills, or reducing problem behavior. Step 6: Manage Behavioral Challenges Many students with Asperger Syndrome view school as a stressful environment. Commonplace academic and social situations can present several stressors to these students that are ongoing and of great magnitude. Students with Asperger Syndrome rarely indicate in any overt way that they are under stress or are experiencing difficulty coping. There is a pattern of behavior, which is sometimes subtle, that can indicate a forthcoming behavioral outburst for a young person with Asperger Syndrome. For example, a student who is not blinking may well be so neurologically overloaded that they have "tuned out. The best intervention for these behavioral outbursts is to prevent them through the use of appropriate academic, environmental, social, and sensory supports and modification to environment and expectations. The Cycle of Tantrums, Rage, and Meltdowns and Related Interventions Rumbling During the initial stage, young people with Asperger Syndrome exhibit specific behavioral changes that may appear to be minor, such as nail biting, tensing muscles, or otherwise indicating discomfort. During this stage, it is imperative that an adult intervene without becoming part of a struggle. Intervention Effective interventions during this stage include: antiseptic bouncing, proximity control, support from routine and home base. All of these strategies can be effective in stopping the cycle of tantrums, rage, and meltdowns and can help the child regain control with minimal adult support. Rage If behavior is not diffused during the rumbling stage, the young person may move to the rage stage. At this point, the child is disinhibited and acts impulsively, emotionally, and sometimes explosively. Meltdowns are not purposeful, and once the rage stage begins, it most often must run its course. Intervention Emphasis should be placed on child, peer, and adult safety, as well as protection of school, home, or personal property. Of importance here is helping the individual with Asperger Syndrome regain control and preserve dignity.
It is possible that individuals with hypertension selectively died prior to inclusion in this cohort muscle relaxant drug test discount flavoxate 200 mg online, or that the limited variability of blood pressure levels prevented detection of any association muscle spasms yahoo answers discount 200mg flavoxate with amex. In summary muscle relaxers to treat addiction flavoxate 200 mg low cost, while multiple cohorts have been examined for an association between hypertension and cognitive decline using various tests muscle relaxant benzodiazepine cheap 200 mg flavoxate fast delivery, the samples are as heterogeneous as are the outcomes, definitions of hypertension, and results. The strongest results were associated with subjects whose hypertension was untreated and whose cognitive decline was relatively severe. Some studies found results when multiple tests were compared individually with hypertension at baseline, raising the possibility that a positive result could arise by chance. In data not shown this is limited to individuals over the median age of the cohort (> 56 years) at the first visit considered here. We identified one good quality systematic review that examined the relationship between total cholesterol and cognitive impairment and cognitive decline. Two studies examined the relationship between a mild cognitive impairment diagnosis and total cholesterol. Of the studies examining cognitive decline included in the systematic review, only two would have met our inclusion criteria. Our own independent search identified two additional papers (Table 49; detailed evidence tables are provided in Appendix B). There was a trend toward a lower risk of cognitive decline with higher late-life cholesterol in one study,266 but a lack of association in four others. We identified four cohort studies120,238,285,286 and a nested case-control study237 involving 3409 subjects that examined the association between homocysteine and risk of cognitive decline (Table 50). Among the five studies, three were conducted in European communities,237,285,286 and two in U. Three studies237,238,286 used non-fasting homocysteine samples that may not measure bioavailable folate as well as fasting samples. Rather than specifying abnormal homocysteine levels a priori, all studies set thresholds based on population levels. In the nested case-control study, 51 percent of survivors agreed to participate when approached at 10-year followup, and of these, only 68 percent provided blood for analysis. Decline was evaluated as a continuous measure or using different thresholds for decline. The other two studies used multiple cognitive tests to compute a single summary score238 or summary scores for several domains of cognitive function. Analyses of other cognitive outcomes showed inconsistent associations with baseline homocysteine values. The variability in subjects studied, classification of exposure, outcomes measured, and duration of followup may explain the variability in observed associations. However, given the small number of studies and the variability across multiple dimensions, no clear pattern can be determined. In summary, we identified five studies that examined the relationship between baseline homocysteine and cognitive decline. Four of the five studies did not find an association between cognitive decline and homocysteine levels, and two studies found associations using differing definitions of exposure. There is no consistent association between homocysteine levels and cognitive decline. We did not identify any good quality systematic reviews or primary studies that evaluated the association between sleep apnea and risk of cognitive decline. We did not identify any good quality systematic reviews that examined the relationship between weight and cognitive decline. We identified three prospective cohort studies that examined the effects of obesity on cognitive decline. Two of these were conducted in the United States,258,287 while the other was conducted in Australia. There was no a priori calculation of the sample size in any of the studies, but all did control for potential confounders in the analysis. This latter analysis is of greatest relevance to our study question; however, it is important to bear in mind that this is a secondary analysis. In conclusion, all three prospective cohort studies that have examined the association between weight and cognition are inconclusive. A possible explanation for this could be that the effect of weight on cognitive decline is small. It could also be the case that the extremes of weight have an adverse outcome which might be masked by considering weight to be single continuous variable. Future studies are needed to clarify the relationship between weight and cognitive decline and these studies need to consider age at exposure as well as change in weight. Factors considered under this heading include depression, anxiety, and resiliency. We identified 13 cohort studies, involving 32,969 subjects, evaluating the association between depression and categorical outcomes for cognitive impairment. An additional nine studies evaluated the association between depressive symptoms and changes on 26 different measures of cognition analyzed as a continuous measure. Because of the heterogeneity of continuous outcome measures and the similar results to studies using categorical outcomes, these studies will not be discussed in detail. All studies assessed current depressive symptoms using a validated severity measure; two257,296 also assessed antidepressant use at baseline. However, only one study reported an a priori sample size calculation,294 few controlled for psychotropic medication use, and followup rates were low or not reported in over half the studies. Because of the variability in how studies categorized significant depressive symptoms, we did not compute a summary estimate of effect. One study that found no association with depressive symptoms296 found that antidepressant use increased risk. Three of the six studies showed an elevated risk for cognitive decline among those with depressive symptoms at baseline, one showed an elevated risk only for those with persistent depressive symptoms, and two showed no association. The variability in findings is not explained by differences in study population, exposure measurement, or study design. We identified four prospective cohort studies, involving 6297 mid- to late-life adults, examining the association between anxiety and cognitive decline. Subjects with dementia at baseline or either of the two followup assessments were excluded from analyses. A baseline measure of neuroticism was used as a proxy for anxiety, and cognitive outcomes were assessed using 11 different measures. Analyses were adjusted for age, sex, and education level, but not for other psychiatric symptoms. There was no association between the 9-item neuroticism measure and change in cognition for any of the 11 different measures. Analyses were adjusted for age, sex, education, chronic disease count, depressive symptoms, alcohol consumption, and benzodiazepine use. There was no association between anxiety symptoms and cognitive decline for any of the cognitive measures. Only those with baseline anxiety scores and followup (n = 1160, 48 percent) were included in the analyses. There were multiple baseline demographic and clinical differences between those with and without followup, potentially biasing the estimate of association. Analyses were adjusted for age, education, marital status, cognitive function, and vascular risk factors. A sensitivity analysis excluding those with cognitive impairment at baseline showed a stronger association. Cherbuin and colleagues257 followed 2082 cognitively normal adults for 4 years; followup exceeded 80 percent. Anxiety was measured using the Goldberg Anxiety/Depression Scale but a threshold for an abnormal result was not specified. A sample size or power calculation was not reported, but the study likely had low powered to exclude a clinically significant association. In summary, four prospective cohort studies failed to find a consistent association between anxiety symptoms and cognitive decline. One study309 was strengthened by a validated scale for anxiety, measured at multiple time points, but no study used a clinical or criterion-based diagnosis of anxiety disorders. We did not identify any good quality systematic reviews or primary studies that evaluated the association between psychological resiliency and risk of cognitive decline.
References
Rosty C, Geradts J, Sato N, et al. p16 Inactivation in pancreatic intraepithelial neoplasias (PanINs) arising in patients with chronic pancreatitis. Am J Surg Pathol 2003;27(12):1495-1501.
Hall MB. Meniscoplasty of the displaced temporomandibular joint meniscus without violating the inferior joint space. J Oral Maxillofac Surg. 1984;42:788-92.
Brindley GS, Janota I. Observations on cortical blindness and on vascular lesions that cause loss of recent memory. J Neurol Neurosurg Psychiatry 1975;38(5):459-64.
Nestel FP, Price KS, Seemayer TA, et al. Macrophage priming and lipopolysaccharide-triggered release of tumor necrosis factor alpha during graft-versus-host disease. J Exp Med. 1992;175: 405-413.
Martel- Pelletier J, Roubille C, Abram F, et al. First- line analysis of the effects of treatment on progression of structural changes in knee osteoarthritis over 24 months: data from the osteoarthritis initiative progression cohort. Ann Rheum Dis 2015; 74(3):547-56.
Rizzo RJ, Flinn WR, et al. Computed tomography for evaluation of arterial disease in the popliteal fossa. J Vasc Surg 1990; 11:112.
