Papers by Ashley Martinez
Journal of managed care & specialty pharmacy, Apr 1, 2020
BACKGROUND: Older adults are especially susceptible to adverse effects of inappropriate medicatio... more BACKGROUND: Older adults are especially susceptible to adverse effects of inappropriate medication therapy, and anticholinergic medications are common culprits for cognitive dysfunction due to their action on the central nervous system. Medication therapy management (MTM) interventions can aid in deprescribing and reducing inappropriate medication use in older adults. However, there is sparse literature on the long-term sustainability of these interventions. What this study adds follow-up periods for MTM interventions to allow further insights regarding the sustainability of deprescribing efforts in older adults.
Alzheimers & Dementia, Dec 1, 2021
The INCREASE study is based on the hypothesis that targeted reductions in inappropriate medicatio... more The INCREASE study is based on the hypothesis that targeted reductions in inappropriate medication use will bolster cognitive reserve (CR) in individuals at risk for Alzheimer’s Disease (AD), delaying the onset of clinical symptoms, and reducing the prevalence and duration of symptomatic disease.
Alzheimers & Dementia, Dec 1, 2020
BackgroundOlder adults are susceptible to negative cognitive effects induced by inappropriate med... more BackgroundOlder adults are susceptible to negative cognitive effects induced by inappropriate medication use.1 Some individuals may accumulate amyloid‐β deposits before symptomatic expression, suggesting preclinical Alzheimer’s disease (pAD). Inappropriate medication use may interact with this neuropathology to hasten symptomatic AD onset. Thus, we designed INCREASE: a randomized controlled trial (RCT) to improve medication use through targeted medication therapy management (tMTM) and ultimately delay AD symptomatic expression.2 MethodsCommunity‐dwelling non‐demented adults ≥ 65 years old who regularly used ≥1 potentially inappropriate medication3 were recruited for the RCT. Board certified geriatric pharmacists reviewed medication lists and identified medication‐related problems (MRPs) at baseline for all participants before conducting the tMTM intervention. Here, we describe this initial medication review, stratified by pAD status. pAD was defined as total brain relative standardized uptake values > 1.4 for PET amyloid.3 Group differences were identified using Student’s t‐tests.Results79 participants were included in this analysis (mean age 73.9 years [SD 5.9]; 66% female). 12.9 (4.9) baseline medication were reported on average, which did not differ significantly between participants with (14.2 [4.8]) and without (12.3 [5.1]) pAD. The most commonly reported medication classes were proton pump inhibitors, antihistamines, non‐steroidal anti‐inflammatory drugs, and vitamins/supplements. On average, 4.9 (SD 2.3) MRPs were identified per participant (389 MRPs total). The most common causes of MRPs were: 1) a medication not appropriate given the participants’ age and/or medical conditions; 2) dose/frequency too high; and 3) untreated medical condition. The most common recommendation by the pharmacist was to deprescribe the problem medication. There were no differences in the number or causes of MRPs based on pAD status.ConclusionNon‐demented older adults enrolled in an MTM RCT used more than ten medications concurrently, with about 5 MRPs identified in each participant. INCREASE will test the hypothesis that deprescribing these inappropriate medications may delay symptomatic AD. Given that the pharmacokinetics and pharmacodynamics of this population puts them at high risk for adverse drug events including cognitive impairment, future work should continue to optimize medication use to prevent cognitive decline. References: 1. Moga DC, et al. Trials. 2019;20(1):806. 2. Jack CR, et al. Brain. 2015;138(12):3747‐3759. 3. American Geriatrics Society. J Am Geriatr Soc. 2015;63(11):2227‐2246.
Alzheimers & Dementia, Dec 1, 2020
Background: The neuroanatomic substrate for cognitive reserve has been poorly elucidated. The dev... more Background: The neuroanatomic substrate for cognitive reserve has been poorly elucidated. The development of antemortem biomarkers such as amyloid-PET afford the potential to begin to explore regional pathologic burden with overt cognitive performance as well as cognitive resilience in relation to neuroanatomic distributions of pathology. The present study sought to identify the relationship between regional amyloid burden and objective measures of cognitive reserve for memory function. Method: Sixty-two subjects with normal cognition or mild cognitive impairment from the INCREASE randomized controlled trial (R01AG054130) underwent amyloid-PET imaging with Amyvid® tracer, and regional SUVr was determined using the Siemens Syngo.via® Neurology software package. Participants underwent cognitive testing with the Montréal Cognitive Assessment (MOCA) and California Verbal Learning Test (CVLT) while challenged with 1.5mg transdermal scopolamine and four weeks later in an unchallenged state. Cognitive reserve (CR) was operationalized by subtracting the scopolamine-challenged score from unchallenged test performance for CVLT trials 1-5 total learning. The relationship between regional SUVr and unchallenged as well as CR cognitive test performance was analyzed using adjusted linear regression models. Result: Subjects included 39 women (63%) and 23 men (37%) with a mean age of 73.1±6.2 years, education 16.5±2.7 years, MOCA 25.8± 2.5, and CVLT 45.2± 11.6. Global amyloid-PET SUVr ranged from 0.9-2.0 and CVLT CR scores ranged from-12 to 34. While, age and education adjusted linear regression analysis demonstrated that unchallenged MOCA and CVLT scores were not significantly related to global SUVr in this sample, reduced CVLT CR was associated with increased global SUVr (p<0.05). Regional analysis demonstrated that this effect was mediated by amyloid deposition in the frontal ((p=0.009), medial temporal (p=0.019), and limbic (p=0.030) regions. Conclusion: These data demonstrate that cognitive reserve for memory functions is particularly sensitive to amyloid deposition in frontotemporal regions intrinsic or connected to the Papez circuit. While this finding is not surprising, it does provide
JAMA, May 24, 2022
In June 2020, preliminary results for the Randomised Evaluation of COVID-19 Therapy (RECOVERY) tr... more In June 2020, preliminary results for the Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial conducted in the UK indicated benefit from dexamethasone in severely ill hospitalized patients with COVID-19 but potential harm in those not requiring oxygen. 1,2 In October 2020, the National Institutes of Health (NIH) issued COVID-19 treatment guidelines advising against systemic corticosteroid use in patients with mild to moderate COVID-19. 1 Using 2 large US health care claims databases, we examined systemic corticosteroid use among nonhospitalized patients with COVID-19. Methods | Data from Medicare fee-for-service and the US Food and Drug Administration's (FDA's) Sentinel System were used. Medicare is a federal health insurance program mostly serving those aged 65 years or older. 3 The Sentinel System comprises primarily claims data from commercially insured patients of all ages in a distributed network of data partners. 4 The Sentinel Rapid COVID-19 data source used in this analysis included 2 national insurance claims data partners and 2 integrated delivery care systems. Nonhospitalized, noninstitutionalized patients with incident COVID-19 between April 2020 and August 2021 (July 2021 for Sentinel) were included. Incident outpatient COVID-19 was defined as a diagnosis code for COVID-19 or positive SARS-CoV-2 laboratory test (Sentinel only) recorded on an outpatient claim, including emergency department claims without subsequent hospitalization. Those with COVID-19 within the prior 183 days and those with use of systemic corticosteroids within the prior 90 days were excluded. Patients were followed up from COVID-19 diagnosis date until the earliest occurrence of a claim for a new oral or injectable corticosteroid in an outpatient setting, hospitalization, death, disenrollment, or 14 days. Demographics, clinical characteristics, and among corticosteroid initiators, corticosteroid type, timing,
BMC Geriatrics, Mar 10, 2023
Background Polypharmacy and inappropriate medications may be a modifiable risk factor for Alzheim... more Background Polypharmacy and inappropriate medications may be a modifiable risk factor for Alzheimer's Disease and Related Dementias (ADRD). Medication therapy management (MTM) interventions may mitigate medicationinduced cognitive dysfunction and delay onset of symptomatic impairment. The objective of the current study is to describe an MTM protocol for a patient-centered team intervention (pharmacist and non-pharmacist clinician) in a randomized controlled trial (RCT) directed at delaying the symptomatic onset of ADRD. Methods Community dwelling adults 65 + years, non-demented, using ≥ 1 potentially inappropriate medications (PIM) were enrolled in an RCT to evaluate the effect of an MTM intervention on improving medication appropriateness and cognition (NCT02849639). The MTM intervention involved a three-step process: (1) pharmacist identified potential medication-related problems (MRPs) and made initial recommendations for prescribed and over-the-counter medications, vitamins, and supplements; (2) study team reviewed all initial recommendations together with the participants, allowing for revisions prior to the finalized recommendations; (3) participant responses to final recommendations were recorded. Here, we describe initial recommendations, changes during team engagement, and participant responses to final recommendations. Results Among the 90 participants, a mean 6.7 ± 3.6 MRPs per participant were reported. Of the 259 initial MTM recommendations made for the treatment group participants (N = 46), 40% percent underwent revisions in the second step. Participants reported willingness to adopt 46% of final recommendations and expressed need for additional primary care input in response to 38% of final recommendations. Willingness to adopt final recommendations was highest when therapeutic switches were offered and/or with anticholinergic medications. Conclusion The evaluation of modifications to MTM recommendations demonstrated that pharmacists' initial MTM recommendations often changed following the participation in the multidisciplinary decision-making process that incorporated patient preferences. The team was encouraged to see a correlation between engaging patients and a positive overall response towards participant acceptance of final MTM recommendations. Trial registration Study registration number: clinicaltrial.gov NCT02849639 registered on 29/07/2016.
Journal of the advanced practitioner in oncology, Sep 1, 2022
Talazoparib is a poly(ADP-ribose) polymerase (PARP) inhibitor that has demonstrated strong effica... more Talazoparib is a poly(ADP-ribose) polymerase (PARP) inhibitor that has demonstrated strong efficacy with manageable side effects for patients with germline breast cancer susceptibility genes 1 or 2 (gBRCA1/2)- mutated, human epidermal growth factor receptor 2–negative, locally advanced or metastatic breast cancer (mBC) in the EMBRACA and ABRAZO trials. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Breast Cancer recommend genetic testing for all patients with recurrent or metastatic BC to identify those with a gBRCA1/2 mutation who would benefit from treatment with a PARP inhibitor. However, many patients who meet these criteria do not receive genetic testing for a variety of reasons. Advanced practitioners (APs) can play a key role in the care of these patients by guiding them through the genetic testing process and explaining how the results impact treatment choices. A hypothetical case study highlighting a 42-year-old woman who received a diagnosis of triple-negative mBC provides an example of genetic testing strategies, as well as management considerations, with the use of talazoparib that can be implemented by APs. The efficacy and safety of talazoparib are reviewed along with practical guidance on its use (i.e., managing adverse events and drug interactions) to optimize patient outcomes. The patient case described in this publication is fictional and does not represent actual events or a response from an actual patient. The authors developed this fictional case for educational purposes only.
Gastrointestinal Endoscopy, Jun 1, 2022
Behavioral Sleep Medicine, Aug 30, 2019
Objective/Background:Appalachian women are disproportionately affected by insufficient sleep but ... more Objective/Background:Appalachian women are disproportionately affected by insufficient sleep but live in a healthcare shortage area with prevalent prescription drug abuse. A self-administered, non-pharmacologic intervention such as Internet-based cognitive behavioral therapy for insomnia (CBT-I) may be ideal in this population, but psycho-social characteristics (e.g., high depression rates) and cultural norms (e.g., suspicion of technology) necessitate a pilot study. We evaluated the effectiveness of Sleep Healthy Using the Internet (SHUTi) on insomnia severity, sleep quality, perceived stress, depression symptoms, and sleep aid use in Appalachian women ages 45+.Participants:Forty-six women enrolled; 38 completed the six-week intervention in 2018 (mean age 55 years).Methods:We employed a single group, pre/post-test, mixed-methods design. Participants completed an online survey and a qualitative interview pre- and post-intervention. Quantitative data were analyzed using one-way repeated measures ANOVA or generalized estimating equations. Interviews were qualitatively analyzed using a multi-stage coding process.Results:Positive and statistically significant (p<0.01) improvements were observed on mean scores for the Insomnia Severity Index (15.1 to 6.5), the Pittsburgh Sleep Quality Index (12.1 to 8.5), the Perceived Stress Scale (20 to 14.6), and the Center for Epidemiologic Studies Depression Scale Revised (9.8 to 5.2). The odds of reporting sleep medication use post-intervention were significantly lower than pre-intervention (OR 0.28 [95% CI 0.11–0.74]). Interviews highlighted most and least helpful intervention components and suggested that participants benefitted from SHUTi.Conclusions:Internet-based CBT-I may be a useful, non-pharmacologic treatment that reduces insomnia severity, perceived stress, depression symptoms, and sleep aid use in middle-aged Appalachian women.
Research in Social & Administrative Pharmacy, Oct 1, 2020
Background: Patients' attitudes toward deprescribing are crucial to understand before developing ... more Background: Patients' attitudes toward deprescribing are crucial to understand before developing interventions, but no such data exists in the medically underserved, health disparities population of rural Appalachian United States. Objective(s): Assess Appalachian women's openness to deprescribing medications and determine if polypharmacy influenced their attitudes toward deprescribing. Methods: Before and after a cognitive behavioral therapy intervention, middle-aged Appalachian women self-reported medication use and completed the revised Patients' Attitudes Toward Deprescribing Questionnaire (rPATD). Responses were described, stratified by presence of polypharmacy. Results: 30 women completed the rPATD pre-and post-intervention (mean [SD] age 55.8 [6.6] years; 96.7% white). Those with polypharmacy (n = 16) had higher burden and involvement scores (median 2.8 vs 2.0, p = 0.01; 4.9 vs 4.6, p = 0.06), and lower appropriateness scores (3.4 vs 3.9, p = 0.04). Burden, concerns about stopping, and involvement factor scores were similar before and after the intervention (p = 0.08, 0.86, and 0.41 respectively). ≥90% of participants were satisfied with their current medications yet would be willing to stop one or more. Conclusions: Middle-aged women in rural Appalachian United States are open to deprescribing; polypharmacy is associated with lower belief in the appropriateness of medications. Larger studies are needed to inform future deprescribing interventions for this and other similarly disadvantaged populations.
Trials, Dec 1, 2019
Background: The course of Alzheimer's disease (AD) includes a 10-20-year preclinical period with ... more Background: The course of Alzheimer's disease (AD) includes a 10-20-year preclinical period with progressive accumulation of amyloid β (Aβ) plaques and neurofibrillary tangles in the absence of symptomatic cognitive or functional decline. The duration of this preclinical stage in part depends on the rate of pathologic progression, which is offset by compensatory mechanisms, referred to as cognitive reserve (CR). Comorbid medical conditions, psychosocial stressors, and inappropriate medication use may lower CR, hastening the onset of symptomatic AD. Here, we describe a randomized controlled trial (RCT) designed to test the efficacy of a medication therapy management (MTM) intervention to reduce inappropriate medication use, bolster cognitive reserve, and ultimately delay symptomatic AD. Methods/design: Our study aims to enroll 90 non-demented community-dwelling adults ≥ 65 years of age. Participants will undergo positron emission tomography (PET) scans, measuring Aβ levels using standardized uptake value ratios (SUVr). Participants will be randomly assigned to MTM intervention or control, stratified by Aβ levels, and followed for 12 months via in-person and telephone visits. Outcomes of interest include: (1) medication appropriateness (measured with the Medication Appropriateness Index (MAI)); (2) scores from Trail Making Test B (TMTB), Montreal Cognitive Assessment (MoCA), and California Verbal Learning Test (CVLT); (3) perceived health status (measured with the SF-36). We will also evaluate pre-to post-intervention change in: (1) use of inappropriate medications as measured by MAI; 2) CR Change Score (CRCS), defined as the difference in scopolamine-challenged vs unchallenged cognitive scores at baseline and followup. Baseline Aβ SUVr will be used to examine the relative impact of preclinical AD (pAD) pathology on CRCS, as well as the interplay of amyloid burden with inappropriate medication use. Discussion: This manuscript describes the protocol of INCREASE ("INtervention for Cognitive Reserve Enhancement in delaying the onset of Alzheimer's Symptomatic Expression"): a randomized controlled trial that investigates the impact of deprescribing inappropriate medications and optimizing medication regimens on potentially delaying the onset of symptomatic AD and AD-related dementias.
Infection Control and Hospital Epidemiology, Apr 27, 2023
who might have become infected during the first 48-72 hours of hospital stay and had shorter incu... more who might have become infected during the first 48-72 hours of hospital stay and had shorter incubation periods (associated with severe disease progression 4) would have been automatically excluded from further chart review. Consideration of using fewer days of hospitalization as a screening criterion for hospital-acquired COVID-19 is particularly relevant today given the emergence of SARS-CoV-2 strains (eg, α, β, δ, and ο) with shorter incubation periods compared to that of the original strain. More specifically, the most recent predominant SARS-CoV-2 strain, ο (omicron), appears to have a mean incubation period of only ∼3 days. 5,6 It would have also been helpful for the authors to have provided additional pertinent demographic features (eg, immunocompromised status and other comorbidities associated with severe COVID-19) of patients who might have acquired COVID-19 during their hospitalization because the incubation period of COVID-19 may reflect not only pathogen-specific characteristics of SARS-CoV-2 but also host factors such as immunity. 4 This information would have been helpful in further characterizing the at-risk population for hospital-acquired COVID-19. The authors also concluded that "hospital-acquired SARS-CoV-2 infection was uncommon" even though SARS-COV-2 disease (ie, COVID-19), not infection, was the primary focus of the study as reflected by the title of the article and study case definitions. 1 Specifically, all SARS-CoV-2-positive patients with "onset during days 6-14" of hospitalization but without COVID-19 symptoms were automatically excluded from further consideration of acquisition in the hospital, whereas those diagnosed during the same period but with COVID-19 symptoms were considered hospital-acquired cases. 1 Furthermore, no patient without COVID-19 symptoms was classified as a "possible" hospital-acquired case unless testing was performed after 14 days of hospitalization. With an estimated 40%-45% of persons who test positive for SARS-CoV-2 considered asymptomatic at the time of testing, 7 a significant fraction of nosocomially transmitted SARS-CoV-2 infection or PCR-positive cases in this study might have gone undetected in the absence of reported symptoms that would have triggered testing by providers. Even among symptomatic patients, as stated by the authors, providers often preferentially ordered SARS-CoV-2 testing in those with more severe symptoms (eg, dyspnea or hypoxia) rather than those with milder symptoms. 1 For these reasons, we believe that no firm conclusion can be made on the frequency of hospital-acquired
Alzheimers & Dementia, Jul 1, 2019
Alzheimers & Dementia, Jul 1, 2018
cohort is the chilean core clinical project of the new Gerocenter on Brain Health and Metabolism ... more cohort is the chilean core clinical project of the new Gerocenter on Brain Health and Metabolism (GERO). Methods: The Gero cohort aims at recruiting 300 elderly subjects (>70 years) from three areas of Santiago(Chile) following them up for at least 3 years. Eligible people are non-demented adults with a subjective cognitive complaint, which is reported by the participant and/or a knowledgeable informant. Participants are identified through a household census . The protocol of evaluation is based on a multidimensional approach: socio-demographic, general medical/ nursing, psychosocial, neuropsychological, neuropsychiatric, motor, neuroimaging, blood biomarkers and a genetic sample. Gero’s biobank stores blood samples which keep for long-term storage at -80 C in liquid nitrogen. The multidimensional protocol of evaluation is administered in months 0 (baseline), 18, and 36. In addition, in months 6, 24, and 30 a telephone interview will be done to collect data for a follow up protocol. Results: To our date the Gero cohort now includes over 50 subjects, and the majority of these have had a multilevel assessment and blood intake. Conclusions: Our work will allow us to determine the risks factors (biomedical, clinical and psychosocial) associated with the prognosis of elderly with cognitive complaint on the evolution to a significant functional decline. The Gero cohort will help to design public health policies tailored to prevent aging disease, and contribute to a better understanding of cognitive impairment and dementia in Latin America and the world. Gero’s aim is to establish a center for studying Brain Ageing in Chile including basic and clinical research.
Alzheimers & Dementia, Dec 1, 2020
Background: Falls, a leading cause of disability and mortality in older adults, 1 are associated ... more Background: Falls, a leading cause of disability and mortality in older adults, 1 are associated cognitive impairment and inappropriate medication use. 2 We propose a novel construct, "mobility reserve" (MR), which describes an individual's resilience against mobility decline. We hypothesize that augmenting MR may delay fall-associated morbidity. Here, we investigate the association between MR and inappropriate medication use among participants with and without preclinical Alzheimer's disease (pAD) enrolled in a randomized medication therapy management trial. 3 Methods: Non-demented older adults who used ≥1 potentially inappropriate medication 4 were recruited for the RCT. The Medication Appropriateness Index was calculated for all medications (MAI) and for potentially inappropriate medications (MAI-PIM). Participants' gait speed (cm/s) was measured under normal conditions and while challenged with 1.5mg of scopolamine to unmask vulnerability. The difference in gait speeds was calculated as mobility reserve change score (MRCS). PET amyloid total brain relative standardized uptake values > 1.4 was used to define pAD. 5 Spearman correlation coefficients (r s) assessed the relationship between medication appropriateness and MRCS. Results: 36 participants were included in this analysis (mean age 75.0 years [SD 6.0]; 78% female); 10 (27.8%) were classified as pAD. The mean (SD) MAI and MAI-PIM were 10.3 (5.1) and 5.4 (4.0) respectively, not differing by pAD status (p=0.92 and 0.11 for MAI and MAI-PIM). The mean (SD) MRCS was-0.39 cm/s (9.4) (no difference by pAD status; p=0.84). Among those with pAD, MAI and MAI-PIM were negatively correlated with MRCS (r =-0.53 and-0.46 respectively), which was not the case among those without pAD (r = 0.37 and 0.34), though a larger sample size is needed to add confidence to these estimates.
Alzheimers & Dementia, Dec 1, 2020
Background: Augmenting cognitive reserve (CR) may delay the progression from preclinical Alzheime... more Background: Augmenting cognitive reserve (CR) may delay the progression from preclinical Alzheimer's disease (pAD) to symptomatic AD. Because studies have shown that potentially inappropriate medication (PIM) use may lower CR, 1 optimizing individual medication regimens may protect against AD dementia symptomatic onset. We investigated the association between baseline measures of CR and PIM use among participants enrolled in a randomized medication therapy management trial. 2 Methods: Participants completed cognitive tests-Trail Making Tests A and B (TMT) and California Verbal Learning Test Trials 1-5 (CVLT)-while wearing a 1.5mg scopolamine patch ("challenged") and again four weeks later under normal conditions ("unchallenged"). Change scores between the challenged and unchallenged tests (standardized for age, sex, and education) were used as a surrogate for CR. The Medication Appropriateness Index for medications considered potentially inappropriate for older adults based on the 2015 Beers Criteria 3 served as a measure of PIM use (MAI-PIM). pAD was defined as total brain relative standardized uptake values > 1.4 using amyloid PET. 4 Spearman correlation coefficients (r s) assessed the relationship between MAI-PIM and CR. Results: Included participants (N=79) had mean age 73.9 years [SD 5.9] and were 66% female; 31.6% met pAD criteria. The median (IQR) PIMs reported at baseline was 2 (2-3). Participants with and without pAD had similar mean (SD) baseline change scores for TMT B minus A (-0.17 [1.37] and-0.13 [1.10] respectively; p=0.90), but lower total CVLT change scores (-0.85 [0.84] and-0.29 [0.83]; p=0.01). Higher MAI-PIM was also correlated with lower baseline CVLT change scores (r s =-0.16), driven by the participants with pAD (r s =-0.33). TMT B minus A change scores and MAI-PIM were uncorrelated (r s =0.02). Conclusion: Among community-dwelling non-demented older adults, executive function and total learning CR was operationalized via participants' abilities to
Alzheimers & Dementia, Jul 1, 2018
Alzheimers & Dementia, Jul 1, 2018
nally. Here, we present the groups’ trajectories of cognitive change from baseline to first follo... more nally. Here, we present the groups’ trajectories of cognitive change from baseline to first follow-up. Methods:Eighty participants aged 40-89 completed verbal phonemic fluency, forward/ backward digit span, Trails A/B, Stroop, and the Wisconsin Card-Sorting Task (WCST). Participants with ADHD (n1⁄441) were identified using a selfand spouse-report questionnaire. Those with MCI (n1⁄439) were diagnosed by an experienced neurologist. All cognitive scores were age-, educationand sexadjusted using data from 116 controls. Performance at each time point and magnitude of change over time, were compared between groups using Mann-Whitney U and t-tests, respectively. Results: First follow-up was 19.4 months following baseline, on average (SD1⁄48.8). At baseline, relative to MCI participants, those with ADHD generated fewer perseverative errors (p1⁄4.012) and intrusions (p1⁄4.019) on semantic fluency, as well as fewer intrusions on phonemic fluency (p1⁄4.022). They made fewer set-loss errors on the WCST (p1⁄4.001) and were faster at completing Trails B (p1⁄4.008). At first follow-up, ADHD participants continued to outperform their MCI counterparts in terms of semantic fluency intrusions (p1⁄4.001), and phonemic perseverations (p1⁄4.003) and intrusions (p1⁄4.013) (Figure). Performance was similar on all other tests. Rates of change did not differ significantly between groups, but trended towards larger magnitudes in the MCI group. Conclusions:Trails B, WCST and verbal fluency in particular may be cost-effective measures to distinguish ADHD from MCI. Fluency may rely relatively more on temporal-lobe than frontal-lobe functions, and may be most sensitive to the earliest stages of Alzheimer’s disease. This preliminary study is an important initial step towards characterizing the longitudinal neuropsychological profile of ADHD in relation to MCI.
Cancer Research
Background: Retinoblastoma is one of the most common eye malignancies in children that develops i... more Background: Retinoblastoma is one of the most common eye malignancies in children that develops in the retina. Repression of the disease is critical in retaining eyesight and reducing mortality. However, most chemotherapeutic agents cause unwanted side effects, often resulting from a lack of target specificity. Various drug delivery systems are being researched to overcome these adverse effects, some of which often utilize nanoparticles such as Cell Membrane Lipid-Extracted Nanoliposomes (CLENs). The objective of this study is to evaluate the selective cytotoxicity and cellular uptake of drug-loaded CLENs and CCK-8 in-vitro assay analysis. Methods: The suspension cell line, Y79, was selected to study the selectivity of drug loaded CLENs in retinoblastoma. Y79 cells were seeded at 20,000 cells/mL of growth medium. Y79-CLENs included DOPC, and lipid extract (LE) derived from the Y79 cell line. Phase I of the experiment examined the cellular uptake activity of the CLENs in the Y79 vary...
Medical Research Archives
Retinoblastoma is the most common type of eye cancer in infants and children. Probability of savi... more Retinoblastoma is the most common type of eye cancer in infants and children. Probability of saving vision and survival depends upon two main factors: progression of the disease from unilateral to bilateral and severity of the disease. In order to effectively treat retinoblastoma and retain vision, it is crucial to focus treatment options on reducing toxicity and nonspecific targeting while enhancing drug delivery, cellular uptake, and accumulation of chemotherapeutic agents to their specific target sites. Rapid elimination from blood circulation is the greatest obstacle that conventional chemotherapeutic agents face on journey to their target sites. Target specific nanoparticles have proven to be a useful tool in efforts to overcome challenges typically encountered by targeting strategies. Development of nanoparticles loaded with chemotherapeutic agents can allow for more selective tumor targeting, extended drug circulation times, and reduced drug-associated toxicity. Nanoparticles...
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Papers by Ashley Martinez