The Changing Spectrum of Cognitive Impairment in People with HIV; Establishment and Updates of the International HIV-Cognition Working Group.

Proyecto DIABDEM: estudio piloto de la prevalencia de deterioro cognitivo en diabetes mellitus en 2 países hispánicos

To use the United States National Health and Nutrition Examination Study (NHANES) to develop and validate a risk-prediction nomogram for cognitive impairment in people aged over 60 years. A total of 2,802 participants (aged ≥ 60 years) from NHANES were analyzed. The least absolute shrinkage and selection operator (LASSO) regression model and multivariable logistic regression analysis were used for variable selection and model development. ROC-AUC, calibration curve, and decision curve analysis (DCA) were used to evaluate the nomogram's performance. The nomogram included five predictors, namely sex, moderate activity, taste problem, age, and education. It demonstrated satisfying discrimination with a AUC of 0.744 (95% confidence interval, 0.696-0.791). The nomogram was well-calibrated according to the calibration curve. The DCA demonstrated that the nomogram was clinically useful. The risk-prediction nomogram for cognitive impairment in people aged over 60 years was effective. All predictors included in this nomogram can be easily accessed from its' user.

Cognitive impairment and depression are among the most prevalent and most disabling non-motor symptoms in Parkinson's disease (PD). The genetic factors that are associated with these symptoms remain uncertain. This systematic review aims to summarise the prevailing evidence from all genetic association studies investigating the genetic variants associated with cognitive impairment and depressive symptoms in people with PD. A systematic review using five online databases: PubMed, PsycINFO, CINAHL, EMBASE and OpenGrey (PROSPERO protocol: CRD42017067431). We completed the quality assessment using the Q-Genie tool. 2353 articles were screened, and 43 articles were found to be eligible to be included. A meta-analysis of studies investigating LRRK2 rs34637584 confirmed that the minor allele carriers had significantly less cognitive impairment (p = 0.015). Further meta-analyses showed that GBA variants rs76763715 (p < 0.001) and rs421016 (p = 0.001) were significantly associated with more cognitive impairment in people with PD. Minor alleles of GBA variants rs76763715, rs421016, rs387906315 and rs80356773 were associated with more depressive symptoms in PD. Moreover, APOE ε4 allele has been associated with more cognitive impairment in PD. BDNF (rs6265) and CRY1 (rs2287161) variants have been associated with more depressive symptoms in people with PD. PD carriers of GBA variants are at high risk for cognitive decline and depression. Screening for these variants may facilitate early identification and effective management of these non-motor symptoms. The molecular mechanisms underlying favourable cognitive functioning in LRRK2 rs34637584 variant carriers warrant further investigation.

Cognitive impairment in people with multiple sclerosis: Perception vs. performance – factors that drive perception of impairment differ for patients and clinicians

ObjectiveTo estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with mild to moderate dementia.DesignMulticentre, pragmatic,...

Cognitive impairment in individuals with rheumatic diseases: the role of systemic inflammation, immunomodulatory medications, and comorbidities

ObjectiveRecent evidence demonstrates that obesity is associated with developing cognitive impairment. However, evidence related to the assessment of mild cognitive impairment (MCI) in people with obesity is limited. Therefore, this systematic review aimed to examine evidence concerning the screening of MCI in people with obesity from the general population.MethodWe conducted a systematic search of CINHAL, EMBASE, MEDLINE, PsycINFO and PubMed electronic databases for observational studies to assess MCI in people with obesity from the general population. PRISMA guideline was followed. The articles published from January 2011 to July 2021 were included.ResultsDatabase search found 3104 sources. After the screening process, two articles from China and Egypt were included. The main age groups assessed were middle-aged adulthood and older adulthood. There were no studies undertaken in young adults or across the life span. Obesity was assessed by body mass index. MCI was assessed by cognitive screening tools; Mini-mental State Examination and Addenbrooke’s Cognitive Examination. The prevalence of MCI in people with obesity was 18.5 % and 42.9 % in Chinese and Egyptian studies, respectively. Only one study supported a positive association between MCI and obesity.ConclusionsLimited studies were found on screening MCI in people with obesity in the general population. The available evidence was not adequate to explain the overall prevalence, possible associations, and the best tool for assessing MCI in people with obesity. Expanding screening studies for MCI in people with obesity in the general population is essential.

Shorter or longer sleep time is an important factor independently related to MCI. Insufficient sleep in men and longer sleep time in women can increase the risk of MCI.

It is becoming increasingly acknowledged that obstructive sleep apnea (OSA) is a variable factor influencing cognitive health. The aims of this study were to explore whether the severity of OSA is related to the occurrence of mild cognitive impairment (MCI) in people with OSA and whether different degrees of daytime sleepiness and nighttime sleep quality are related to MCI. The study was cross-sectional. For our subjects, we selected individuals who visited the Sleep Medicine Center of Jinzhou Medical University's First Affiliated Hospital between May 2023 and October 2024, underwent polysomnography (PSG) or the home sleep apnea test (HSAT), and were diagnosed with OSA. The patients were split into two groups: one for normal cognitive function (NC) and the other for MCI. MCI was defined as Montreal Cognitive Assessment (MOCA) < 26 points. The apnea-hypopnea index (AHI) and the oxygen desaturation index (ODI) were used to assess the severity of sleep apnea. The Epworth Sleepiness Scale (ESS) was used to assess patients' daytime sleepiness, and the Pittsburgh Sleep Quality Index Scale (PSQI) was used to assess their sleep quality. Multivariate logistic regression analysis was used to evaluate the correlation between the variables. In this study, 387 patients with OSA (45.3 ± 12.6 years, 82.4% male) were included, of whom 38% had MCI (52.4 ± 11.9 years, 74.1% male). In the unadjusted model, the sleep apnea severity, daytime sleepiness severity, and different sleep quality at night were positively related to MCI. After controlling for confounding factors, this correlation was no longer significant. Only severe sleep apnea (AHI ≥ 30/h, p < 0.001), poor nighttime sleep quality (PSQI ≥ 9, p = 0.020), and sleepiness (ESS ≥ 11, p < 0.05) were associated with increased risk of MCI. Severe sleep apnea, poor sleep quality, and sleepiness were relevant to increased risk of MCI. It provides a basis for a more comprehensive understanding of the relationship between OSA and MCI.

Parkinson's disease (PD) is an important health problem caused by the degeneration of brain neurons. Bradykinesia and lower balance ability seriously affect the quality of life of people with PD. Non-motor symptoms, such as cognitive impairment, accompany the course of the disease but still lack sufficient attention. In general, drugs combined with cognitive training are the most common ways to improve cognitive impairment in people with PD. However, long-term use of psychiatric drugs may lead to side effects such as brain death and movement disorders. Recently, mindfulness has been used by researchers in the treatment of cognitive impairment, because healthy older adults who engage in mind-body exercises for a long time have higher cognitive levels than normal aging populations. Mind-body exercise, as a therapy that combines concentration, breath control, and physical activity, is beneficial for improving practitioners' brain and mental health. Mind-body exercises such as Tai Chi, yoga, dance, and Pilates can improve cognitive performance in older adults with or without cognitive impairment. Therefore, mind-body exercise may be a feasible strategy for the treatment of cognitive impairment in people with PD. This study summarizes the latest evidence that mind-body exercises including Tai Chi, Qigong, yoga, and dance improve cognitive impairment associated with PD. We also explored the limitations of current mind-body exercise research, aiming to provide new ideas for improving mind-body exercise as a strategy to alleviate cognitive impairment in people with PD.

Current approaches to classifying cognitive impairment in people living with HIV can overestimate disease burden and lead to ambiguity around disease mechanisms. The 2007 criteria for HIV-associated neurocognitive disorders (HAND), sometimes called the Frascati criteria, can falsely classify over 20% of cognitively healthy individuals as having cognitive impairment. Minimum criteria for HAND are met on the basis of performance on cognitive tests alone, which might not be appropriate for populations with diverse educational and socioeconomic backgrounds. Imprecise phenotyping of cognitive impairment can limit mechanistic research, biomarker discovery and treatment trials. Importantly, overestimation of cognitive impairment carries the risk of creating fear among people living with HIV and worsening stigma and discrimination towards these individuals. To address this issue, we established the International HIV-Cognition Working Group, which is globally representative and involves the community of people living with HIV. We reached consensus on six recommendations towards a new approach for diagnosis and classification of cognitive impairment in people living with HIV, intended to focus discussion and debate going forward. We propose the conceptual separation of HIV-associated brain injury - including active or pretreatment legacy damage - from other causes of brain injury occurring in people living with HIV. We suggest moving away from a quantitative neuropsychological approach towards an emphasis on clinical context. Our recommendations are intended to better represent the changing profile of cognitive impairment in people living with HIV in diverse global settings and toprovide a clearer framework of classification for clinical management and research studies.

Background: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. There is heterogeneity of the clinical features of ALS including site of onset and rate of progression. Previously, ALS was considered to be a disease of the motor system. However, there is evidence that ALS patients can have cognitive impairment. Some patients meet the diagnostic criteria for Frontotemporal dementia (FTD). It is now thought that FTD and ALS are related neurodegenerative disorders, which fall on the same disease spectrum. A reliable biomarker is needed to monitor the progression of the disease and assess the effects of potential therapies. Sequential Window Acquisition of all theoretical fragment-ion spectra analysis (SWATHTM) is a reliable and powerful proteomic approach to investigate the biomarker proteins in complex samples such as blood. Method: The aim of the first study is to evaluate the utility of neurofilament levels as blood or cerebrospinal fluid (CSF) biomarker in patients with ALS by using a systematic search of Pubmed, Embase and Scopus databases. Meta-analysis of the data was performed. The aim of the second study is to screen for cognitive and behavioural impairment in people with ALS and controls with neuromuscular disease and to correlate these with clinical features. 108 people with ALS and 60 controls were recruited and assessed with the Addenbrooke’s cognitive examination-III (ACE-III), the Frontal assessment battery (FAB), and the executive function component of the Edinburgh cognitive and behavioural ALS screen (ECAS). The Amyotrophic lateral sclerosis-Frontotemporal dementia questionnaire (ALS-FTD-Q) and the Motor Neuron Disease Behavioural instrument (MiND-B) were administered to the caregivers of people with ALS. Longitudinal studies of cognition were performed in 37 ALS patients. The aim of the third study is to search for plasma biomarkers in ALS patients compared to healthy controls by using SWATH™ quantification analysis and to compare proteomic analysis of ALS patients with and without cognitive impairment (CI). 42 patients with ALS and 18 healthy controls were recruited. Western blot analysis was used to confirm the results of analysis and in an independent set of samples. Ingenuity pathway analysis (IPA) was performed. Results: The systematic review found that levels of NF heavy chain and light chains were significantly elevated in the CSF of ALS patients compared to healthy controls/controls without parenchymal central nervous system (CNS) involvement and ALS mimic disease patients. NF light chain level in CSF was higher in ALS patients than in neurological patients with CNS involvement (SMD=1.352, P=0.001). NF light chain concentration in blood was higher in ALS patients than in healthy controls/controls without CNS involvement (SMD=1.448, P<0.0001). NF heavy chain levels in CSF were negatively correlated disease duration and ALSFRS-R (r=-0.447, P<0.0001; r=-0.279, P=0.011). NF light chain levels in CSF were negatively correlated with disease duration (r=-0.486, P<0.0001). In the patient cohort, the frequencies of cognitive impairment based on the ACE-III and FAB were 30.0% and 14.0%, in ALS and 11.7% and 3.3% in controls, respectively. In ALS, the frequencies of behavioural impairment based on ALS-FTD-Q and MiND-B were 32.1% and 39.4 %, respectively. ALS participants with cognitive impairment measured with ACE-III had significantly shorter survival time than those without. ALS participants with behavioural impairment measured with ALS-FTD-Q had worse prognosis than those without. No significant difference was found between the first two serial cognitive tests based on ACE-III and FAB by using a generalized estimating equation. Between ALS and controls, there were significant differences in the expression of 30 proteins. Of these, plasma gelsolin concentration was 1.2 fold higher in controls than ALS patients (P=0.006). Between controls and ALS with CI, there was significant difference in expression of 32 proteins. The clusterin level was 1.2 fold downregulated in patients with CI compared with controls (P=0.03). The observed changes in levels of gelsolin, clusterin, CD5L and ficolin 3 were validated by using western blot. Pathway analysis showed that the LXR/RXR pathway, complement pathway and coagulation pathway are regulated in ALS. Conclusions: The results of the first study shows that NF heavy and light chain levels have potential to be used as markers of neural degeneration in ALS, but are not specific for the disease, and are more likely to be used as measures of disease progression. The results of second study indicate that there is a greater frequency of cognitive impairment in people with ALS than in patients with other neuromuscular diseases. The cognitive and behavioural tests are potential biomarkers of the prognosis of ALS. The results of cognitive tests are stable over 6 months and possibly longer. The results of the third study illustrate that clusterin, gelsolin and ficolin 3 are novel potential biomarkers to differentiate the ALS patients from healthy controls. Abnormalities in the LXR/RXR pathway suggest that lipid metabolism is involved in ALS. There are widespread changes in immune function and coagulation in ALS.

ObjectivesTo screen for cognitive and behavioural impairment in people with amyotrophic lateral sclerosis (ALS) and controls with neuromuscular disease and to correlate these with clinical features.Methods108 people with ALS and...

Screening for cognitive and behavioural impairment in amyotrophic lateral sclerosis: Frequency of abnormality and effect on survival

The most frequently used criteria for cognitive impairment in people with HIV are the HIV–associated neurocognitive disorders (HAND) criteria, developed in 2007 by a working group formed by the US National Institute of Mental Health.1 The HAND criteria (sometimes referred to as the Frascati criteria) were intended for use in research, but the terminology has become widely used to refer to clinical burden of cognitive impairment in people with HIV across diverse settings globally.2