Changes In Cognitive Symptoms Research Articles

Self-reported cognitive and psychiatric symptoms at 3 months predict single-item measures of fatigue and daytime sleep 12 months after ischemic stroke.

Post-stroke fatigue and increased need for daytime sleep are multidimensional and insufficiently understood sequelae. Our aim was to study the relationships of self-reported cognitive and psychiatric symptoms at 3 months with fatigue and daytime sleep at 12 months post-stroke. Ischemic stroke patients without reported history of dementia or depression completed postal surveys 3- and 12-months post-stroke. At 3 months, psychiatric symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS), and self-reported changes in cognitive symptoms (concentration and memory) compared to pre-stroke were assessed using single-item measures. At 12 months, single-item questions about changes in self-reported difficulties sleeping at night, fatigue and daytime sleep were included. First, we studied whether self-reported cognitive and/or psychiatric symptoms at 3 months were associated with daytime sleep and fatigue at 12 months using multiple logistic regression. Second, we fitted 2 structural equation models (SEMs) predicting fatigue and 2 models predicting daytime sleep. We compared a model where only age, sex, stroke severity (National Institutes of Health Stroke Scale; NIHSS), and difficulties sleeping at night predicted fatigue and daytime sleep at 12 months to a model where mental distress (i.e., a latent variable built of cognitive and psychiatric symptoms) was included as an additional predictor of fatigue and daytime sleep at 12 months. Of 156 patients (NIHSS within 24 hours after admission (mean ± SD) = 3.6 ± 4.3, age = 73.0 ± 10.8, 41% female) 37.9% reported increased daytime sleep and 50.0% fatigue at 12 months. Increased psychiatric symptoms and worsened cognitive symptoms were associated with fatigue and daytime sleep at 12 months, after controlling for NIHSS, age, sex, and difficulties sleeping at night. SEM models including mental distress as predictor showed adequate model fit across 3 fit measures (highest RMSEA = 0.063, lowest CFI and TLI, both 0.975). Models without mental distress were not supported. Self-reported cognitive and psychiatric symptoms at 3 months predict increased daytime sleep and fatigue at 12 months. This highlights the relevance of monitoring cognitive and psychiatric symptoms in the subacute phase post-stroke. However, future research using validated measures of self-reported symptoms are needed to further explore these relationships.

A randomised controlled trial evaluating two cognitive rehabilitation approaches for cancer survivors with perceived cognitive impairment

PurposeUp to 70% of survivors report cognitive symptoms after chemotherapy. We compared two cognitive rehabilitation programs to a control group in cancer survivors.MethodsStudy population were adult cancer survivors with cognitive symptoms 6–60 months after adjuvant chemotherapy. Participants randomised to: Attention Process Training (APT), Compensatory Strategy Training (CST), or control group. Active interventions comprised 6–week, 2–h/week small group sessions. Assessments: pre- and post-intervention, 6- and 12-months later. Primary outcome was change in cognitive symptoms (FACT-COG-PCI subscale) between baseline and post-intervention. Secondary endpoints included objective neuropsychological performance, Functional Impact Assessment (FIA), patient-reported outcome measures, and associations. Analyses were on an intention-to-treat basis. Analysis of covariance mixed models were used for continuous outcomes.ResultsSixty-five participants were randomised (APT n = 21; CST n = 24; controls n = 20): 94% breast cancer, median age 54. Median time since chemotherapy 20.7 months. FACT-COG-PCI, clinical neuropsychological T-scores, and FIA improved in all groups over time, but no significant differences between arms. On mean neuropsychological T-scores 19/65 (29%) were impaired at baseline; post-intervention impairment controls 31.3%, CST 16.7%, APT 20.0%. On FIA at baseline, nine were impaired; this decreased to three post-intervention (one/group). FACT-COG-PCI was weakly associated with neuropsychological tests (rho = 0.24, p = 0.051) at baseline, and had no association with FIA. Neuropsychological total mean T-score was moderately positively associated with FIA (rho = 0.37, p = 0.003).ConclusionThere were no significant differences between intervention groups and controls using linear mixed models adjusted for baseline scores.Implications for Cancer SurvivorsCognitive symptoms and neuropsychological test scores improve over time.

Association of Excessive Daytime Sleepiness with the Zung Self-Rated Depression Subscales in Adults with Coronary Artery Disease and Obstructive Sleep Apnea.

Excessive daytime sleepiness (EDS) is a factor associated with both obstructive sleep apnea (OSA) and depressive symptoms. Continuous positive airway pressure (CPAP) treatment may decrease EDS in adults with OSA; however, the modulatory role of depressive symptoms on the improvement of EDS is not known. We aimed to explore the association between subscales of the Zung Self-rated Depression Scale (SDS) and Epworth Sleepiness Scale (ESS) over a 2-year period in coronary artery disease (CAD) patients with OSA. This was a post-hoc analysis of the RICCADSA cohort, in which 399 adults with CAD (155 sleepy OSA [apnea–hypopnea index ≥ 15/h] and ESS score ≥ 10, who were offered CPAP; and 244 nonsleepy OSA [ESS < 10]), randomized to CPAP [n = 122] or no-CPAP [n = 122]) were included. Three factors were extracted from the Zung SDS, based on the principal component analysis: F1, cognitive symptoms and anhedonia; F2, negative mood; and F3, appetite. In a mixed model, the ESS score decreased by 3.4 points (p < 0.001) among the sleepy OSA phenotype, which was predicted by the decline in the F2, but not in the F1 and F3 scores. The fixed effects of time were not significant in the nonsleepy OSA groups, and thus, further analyses were not applicable. Additional within-group analyses showed a significant decrease in all subscales over time both in the sleepy and nonsleepy OSA patients on CPAP whereas there was a significant increase in the nonsleepy OSA group randomized to no-CPAP. We conclude that the improvement in negative mood symptoms of depression, but not changes in cognitive symptoms and anhedonia as well as appetite, was a significant predictor of decline in the ESS scores over a 2-year period in this CAD cohort with sleepy OSA on CPAP treatment.

Tau Tangles in Parkinson's Disease: A 2-Year Follow-Up Flortaucipir PET Study.

Flortaucipir PET, a marker of tau tangles, has shown lower than expected cortical uptake in Parkinson's disease (PD), than would be predicted from neuropathologic estimates of Alzheimer's disease co-pathology. Instead, the most characteristic finding of flortaucipir imaging in PD is decreased uptake in the substantia nigra, reflecting reduction in its "off-target" binding to neuromelanin. We have previously reported these observations in cross-sectional studies. Here, we present two-year follow-up data of cortical and nigral flortaucipir uptake in PD patients. Seventeen PD patients received repeat flortaucipir PET two years after baseline. We interrogated vertex-based group-wise cortical tracer binding (SUVRs) with a cerebellar reference using the general linear model while mean substantia nigra SUVRs were compared with volumes of interest group comparisons and voxel-wise group analyses using ANOVA. Finally, we performed linear regressions of tau load with changes in MoCA and UPDRS motor scores. We found no significant changes in substantia nigra or cortex flortaucipir uptake in Parkinson's disease patients over two years and no association with changes in cognitive symptoms. Signal reduction in the medial substantia nigra trended towards an association with worsening of motor symptoms. No significant increase in tau tangles occurred after a two-year follow-up of Parkinson's disease patients using flortaucipir PET.

Perceived Benefits of Using Nonpharmacological Interventions in Older Adults With Alzheimer's Disease or Dementia With Lewy Bodies.

The current qualitative research explored perceived effects of three nonpharmacological interventions (chair yoga [CY], participatory music intervention [MI], and chair-based exercise [CBE]) in managing symptoms in older adults with Alzheimer's disease or dementia with Lewy bodies from family caregivers' perspectives. Three focus groups were conducted following completion of the 12-week interventions. Constant comparative analysis determined whether each intervention had perceived effects on symptoms, based on caregivers' perspectives. Three major themes emerged: (a) Changes in Cognitive Symptoms, (b) Changes in Physical Function, and (c) Changes in Mood, Behavioral Symptoms, and Sleep Disturbance. Results can be integrated into treatment plans for older adults with dementia. Future research should focus on CY or CBE with support from caregivers to manage dementia symptoms and compare CY or CBE practiced with caregivers against CBE or CY practiced solely by participants with dementia. [Journal of Gerontological Nursing, 46(1), 37-46.].

The effects of roux en y gastric bypass surgery on neurobehavioral symptom domains associated with severe obesity

BackgroundNeurobehavioral symptoms and cognitive dysfunction related to mood disorders are present in individuals with severe obesity. We sought to determine acute improvements in these symptoms and relationships with adiposity, inflammation, and insulin sensitivity after roux-en-y gastric bypass (RYGB) surgery. MethodsThe self-report Zung Depression Rating (ZDRS) and Neurotoxicity Rating (NRS) scales were administered before, and at 6-months after RYGB surgery in severely obese women (body mass index > 35 kg/m2; N = 19). Symptom domains corresponding to depressed mood/suicide ideation, anxiety, cognitive, somatic, and neurovegetative symptoms were assessed. Biologic measures were of adiposity [leptin, abdominal visceral (VAT) and subcutaneous (SAT) adipose tissue], inflammation [IL-6, C-reactive protein (CRP)], and insulin sensitivity (Si). Spearman correlations and linear regression (adjusted for biologic measures) assessed relationships between changes in biologic measures and changes in neurobehavioral domains. ResultsBy 6-months after RYGB, VAT, SAT, Si, CRP, and IL-6 had improved (p < .05). Anxiety, somatic, and neurovegetative symptoms domains improved (p < .05), but depressed mood/suicidal ideation and cognitive domains did not. Reductions in VAT were associated with decreases in neurovegetative symptoms (beta = 295 ± 85, p < .01). We also found significant positive longitudinal associations between IL-6 concentrations and minor changes in cognitive symptoms. ConclusionAnxiety, somatic and neurovegetative symptoms, improved within 6 months after RYGB, but depressed mood/suicidal ideation and cognitive symptoms did not improve. Associations between visceral adiposity, IL-6 concentrations and neurovegetative and cognitive symptoms support links between obesity, inflammation and distinct neurobehavioral symptoms.

Meta-Analysis of the Relationship between Deep Brain Stimulation in Patients with Parkinson's Disease and Performance in Evaluation Tests for Executive Brain Functions.

Parkinson's disease (PD) is a neurodegenerative condition, which compromises the motor functions and causes the alteration of some executive brain functions. The presence of changes in cognitive symptoms in PD could be due to the procedure of deep brain stimulation (DBS). We searched in several databases for studies that compared performance in executive function tests before and after the DBS procedure in PE and then performed a meta-analysis. After the initial search, there were 15 articles that specifically evaluated the functions of verbal fluency, working memory, cognitive flexibility, abstract thinking, and inhibition. It was found that there were differences in the evaluation of the cognitive functions in terms of the protocols, which generated heterogeneity in the results of the meta-analysis. Likewise, a tendency to diminish functions like verbal fluency and inhibition was found, being this consistent with similar studies. In the other functions evaluated, no difference was found between pre- and postsurgery scores. Monitoring of this type of function is recommended after the procedure.

Personalizing antidepressant choice by sex, body mass index, and symptom profile: An iSPOT-D report

Antidepressants are efficacious but we do not know which antidepressant is best suited to which person. We investigated the working hypothesis that obesity and sex may together be differential predictors of acute remission of specific symptoms for commonly used antidepressant medications. Data were acquired for 659 outpatients (18–65years of age) who completed the iSPOT-D practical randomized controlled clinical trial. We measured adiposity by body mass index (BMI). By WHO criteria, 42% of patients were normal weight, 28% overweight and 31%, obese [class I (15%), II (10%) and III (6%)]. Patients were randomly assigned to 8-weeks of treatment with escitalopram, sertraline or venlafaxine extended-release (venlafaxine-XR) and then defined as remitters (17-item Hamilton Rating Scale for Depression score ⩽7) or non-remitters. In logistic regression models, BMI was a differential predictor of remission according to antidepressant type. Morbidly obese patients, compared to those with normal weight, were more likely to remit on venlafaxine-XR in particular. This effect was driven by a reduction specifically in physical symptoms, including sleep disturbance, somatic anxiety and appetite. The number needed to treat to achieve remission with venlafaxine-XR in obese III participants was 6. Higher BMI females but not males were more likely to remit regardless of medication type; this effect was related to a change in cognitive symptoms, including suicidal ideation, guilt, and psychomotor changes. Our findings suggest that considering BMI and sex, and assessing specific symptoms, could help tailor antidepressant choices to improve remission from depression in specialty and primary care settings.

Changes in cognitive symptoms after a buspirone–melatonin combination treatment for Major Depressive Disorder

Cognitive deficits are often associated with acute depressive episodes and contribute to the functional impairment seen in patients with Major Depressive Disorder (MDD). Many patients sustain residual cognitive deficits after treatment that may be independent of the core MDD disorder. We tracked changes in cognitive deficits relative to antidepressant treatment response using the patient self-rated Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (MGH-CPFQ) during a 6-week, double-blind trial of a combination antidepressant treatment (buspirone 15 mg with melatonin-SR 3 mg) versus buspirone (15 mg) monotherapy versus placebo in MDD patients with acute depressive episodes. The CPFQ includes distinct cognitive and physical functioning dimension subscales. Treatment response was determined using the Inventory of Depressive Symptomatology (IDSc30). Treatment responders improved significantly more on the total CPFQ than non-responders (p < 0.0001) regardless of treatment assignment. The cognitive dimension of the CPFQ score favored the combination treatment over the other two groups (ANCOVA: p = 0.050). Among the treatment non-responders, the effect size for the CPFQ cognitive dimension was 0.603 favoring the combination treatment over the over two groups and 0.113 for the CPFQ physical dimension. These preliminary findings suggest that a combination of buspirone with melatonin may benefit cognitive function distinct from mood symptoms and that some aspects of cognition may be specific targets for treatment within a population of patients with MDD.

Feasibility and perception of the impact from aerobic exercise in older adults with Alzheimer's disease.

The subjective experience of participating in aerobic exercise is unknown in Alzheimer's disease (AD). The purpose of this study was to understand the subjective perceptions of the feasibility and impact of a 6-month, moderate-intensity aerobic exercise intervention by older adults with AD and their family caregivers. Ten older adults with AD who completed the intervention and their family caregivers participated in four focus group interviews. Four converging themes were identified: "There was no perceived positive change in cognitive symptoms," "The 6-month exercise program was socially rewarding," "The 6-month exercise program increased physical strength," and "Participation in aerobic exercise was a positive experience." Family caregivers further identified two additional themes: "The exercise program led to improved attitude in older adults with AD" and "The exercise program reduced caregiver stress." Aerobic exercise is a feasible and well-perceived intervention for older adults with AD and their family caregivers.

Safety and Effectiveness of a Traditional Ginkgo Fresh Plant Extract – Results from a Clinical Trial

Background: In Chinese medicine, Ginkgo biloba is used for a variety of indications. In the current study, the safety and efficacy of a traditional fresh plant extract was investigated in patients with mild cognitive impairment. Patients and Methods: 59 elderly patients were treated for 6 weeks with a twice daily tablet containing 90 mg of fresh plant Ginkgo biloba extract. The patients suffered from agerelated mild cognitive impairment of the non-Alzheimer type assessed by the DemTect score and the presence of symptoms, such as forgetfulness, memory problems, and difficulties in concentration. At the end of the treatment period, safety was primarily assessed by the occurrence of adverse events and efficacy by the DemTect score, the SF-12 quality of life questionnaire, and the change in cognitive symptoms, as well as the judgment of the investigators and patients. Results: At the final visit, the SF-12 mental score had increased significantly from 48.3 ± 10.1 to 51.3 ± 7.9, whereas the SF-12 body score (44.5 ± 9.2 to 45.3 ± 8.1) and the DemTect score (15.9 ± 2.0 to 16.0 ± 2.3) had not changed significantly. About half of all patients experienced an improvement in their memory and their ability to concentrate, as well as a decrease in symptoms of forgetfulness. The majority of investigators and patients judged the treatment to be effective. The tablets were very well tolerated and, as a treatment for their cognitive impairment, highly accepted (90% would take them again). Conclusion: This newly developed, holistic fresh leaf extract of Ginkgo biloba is a safe, effective, and, at least, adjuvant treatment option for patients with mild cognitive impairments.

Cognitive Symptoms in Persons with Schizophrenia Assessed by PANSS in the Acute Phase and 9 Months Later

Introduction:Cognitive impairment is a relatively frequent aspect of schizophrenia and it impedes psychosocial performance and ability to reintegrate into society.Problem statement:Test if there is a significant change in cognitive symptoms from the acute phase to nine months follow up and to identify patterns of change in cognitive symptoms.Method:The sample comprised 36 patients with schizophrenia, admitted to psychiatric units for an acute psychotic episode.Measurements:Cognitive symptoms were assessed by PANSS at baseline and follow-up.Results:Four out of six symptoms are significantly reduced from baseline to follow-up. At follow-up, nearly half of the patient group had residual symptoms. About one third was at a stable level.Discussion:Results from the current study suggests that the cognitive symptoms in patients with schizophrenia significantly changes from the acute psychotic phase to nine months later, but there is a wide variety within symptoms and patients. The results are discussed in relation to the patients and to his/relationship with family. Assessing cognitive symptoms in patients would be an easier way of measuring change when planning for and trying out interventions for the purpose of maintaining or changing the cognitive dysfunction that is embedded in a group of patients suffering from schizophrenia.