Changes In Neurocognitive Function Research Articles

Effects of propofol and sevoflurane on early congnitive function of elderly patients after ambulatory surgery

Objective To investigate the effects of two approaches of anesthesia maintenance, propofol and sevoflurane, on early cognitive function of elderly patients after ambulatory surgery. Methods Sixty elderly patients who were scheduled for laparoscopic cholecystectomy as ambulatory surgery were selected. The patients were divided into two groups according to the random number table method (n=30): a propofol group and a sevoflurane group. Neuropsychological test scores were recorded one day before surgery and 24 h after surgery respectively. Venous blood was extracted before anesthesia induction and 24 h after surgery. The levels of plasma insulin-like growth factor 1 (IGF-1), serum interleukin (IL)-6, IL-1β and tumor necrosis factor-α (TNF-α) were determined by enzyme linked immunosorbent assay (ELISA). Both groups were compared for the scale scores and inflammatory factor changes before and after surgery. Results Both approaches of anesthesia maintenance could result in postoperative neurocognitive function changes in some patients, including 2 cases (6.9%) in the sevoflurane group and 2 cases (6.7%) in the propofol group, without statistical difference in the incidence between the two groups (P>0.05). There was no statistical difference in neuropsychological test scores between the two groups before and after surgery (P>0.05). There was no statistical difference in the levels of inflammatory factors between the two groups before anesthesia induction and 24 h after surgery (P>0.05). Conclusions These two approaches of general anesthesia maintenance have no effect on the changes of early cognitive function in elderly patients after ambulatory surgery, without effect on the levels of blood inflammatory factors 24 h after surgery. Key words: Elderly people; Neurocognitive disorder; Ambulatory surgery; Anesthesia, general; Propofol; Sevoflurane

The neurocognitive function change criteria after whole-brain radiation therapy for brain metastasis, in reference to health-related quality of life changes: a prospective observation study

BackgroundWe sought to construct the optimal neurocognitive function (NCF) change criteria sensitive to health-related quality of life (HR-QOL) in patients who have undergone whole-brain radiation therapy (WBRT) for brain metastasis.MethodsWe categorized the patients by the changes of NCF into groups of improvement versus deterioration if at least one domain showed changes that exceeded the cut-off while other domains remained stable. The remaining patients were categorized as stable, and the patients who showed both significant improvement and deterioration were categorized as ‘both.’ We examined the clinical meaning of NCF changes using the cut-off values 1.0, 1.5, and 2.0 SD based on the percentage of patients whose HR-QOL changes were ≥ 10 points.ResultsBaseline, 4-month and 8-month data were available in 78, 41 (compliance; 85%), and 29 (81%) patients, respectively. At 4 months, improvement/stable/deterioration/both was seen in 15%/12%/41%/32% of the patients when 1.0 SD was used; 19%/22%/37%/22% with 1.5 SD, and 17%/37%/37%/9% with 2.0 SD. The HR-QOL scores on the QLQ-C30 functional scale were significantly worse in the deterioration group versus the others with 1.0 SD (p = 0.013) and 1.5 SD (p = 0.015). With 1.5 SD, the HR-QOL scores on the QLQ-BN20 was significantly better in the improvement group versus the others (p = 0.033). However, when ‘both’ was included in ‘improvement’ or ‘deterioration,’ no significant difference in HR-QOL was detected.ConclusionsThe NCF cut-off of 1.5 SD and the exclusion of ‘both’ patients from the ‘deterioration’ and ‘improvement’ groups best reflects HR-QOL changes.

Hippocampal-sparing radiotherapy and neurocognitive impairment: A systematic literature review.

Whole-brain radiation therapy (WBRT) is an effective therapeutic modality in patients with brain metastases. However, nearly 90% of patients undergoing WBRT suffer from a neurocognitive function (NCF) impairment at diagnosis, and up to two-thirds will experience a further decline within 2-6 months after WBRT. Focal-dose reduction on bilateral hippocampus is thought to improve NCF preservation. The aim was to present a systematic review of clinical results on NCF after hippocampal-sparing (HS) WBRT. A systematic review of published literature was performed on PubMed and the Cochrane Library. Only prospective clinical trials reporting NCF outcome in patients treated with HS-WBRT have been analyzed. A total of 165 patients from three studies were included. These studies are characterized by small sample size and different methods in terms of WBRT technique but with similar planning analysis and NCF assessment tests. No significant changes in NCF (i.e., verbal and nonverbal learning memory, executive functions, and psychomotor speed) between baseline and 4-month follow-up after RT and only a mean relative decline in delayed recall at 4 months (7% compared to 30% of historical control) were observed. Considering preliminary results on NCF preservation, further studies seem justified in patients undergoing brain irradiation for brain metastases or referred for prophylactic cranial irradiation to evaluate long-term effects on NCF and quality of life.

Changes in neurocognitive function and central nervous system structure in childhood acute lymphoblastic leukaemia survivors after treatment: a meta-analysis.

Acute lymphoblastic leukaemia (ALL) is the most common malignancy in children. Although the survival rate has increased dramatically over the last decades, patients struggle with the adverse side effects of treatment. Treatment for ALL includes chemotherapy and irradiation - both of which are linked to cognitive impairments and alterations in central nervous system (CNS) structure and function detected by neuroimaging and in neurocognitive studies. The present article is a meta-analysis of the existing evidence for the mechanisms underlying changes in the CNS and neurocognitive function in ALL survivors after treatment. We found that compared with controls, ALL survivors develop: (i) cognitive sequelae in intelligence, academics, attention, memory, processing speed and executive function domains; (ii) decreased grey and white matter volume in cortical and several subcortical brain regions, with functional changes particularly in frontal regions and the hippocampus; (iii) neurocognitive impairments related to CNS changes; and (iv) reduction, but not resolution, of late neurocognitive sequelae in patients in whom prophylactic irradiation was replaced by systemic/intrathecal chemotherapy. Continued work with advanced functional magnetic resonance imaging techniques will hopefully allow the detection of early CNS changes as biomarkers to help guide early diagnosis and intervention for neurocognitive defects in patients with childhood ALL.

Housing Stability and Neurocognitive Functioning in Homeless Adults With Mental Illness: A Subgroup Analysis of the At Home/Chez Soi Study.

Objective: This study examined the association of housing stability with neurocognitive outcomes of a well-characterized sample of homeless adults with mental illness over 18 months and sought to identify demographic and clinical variables associated with changes in neurocognitive functioning.Method: A total of 902 participants in the At Home/Chez Soi study completed neuropsychological measures 6 and 24 months after study enrollment to assess neurocognitive functioning, specifically verbal learning and memory, cognitive flexibility, and complex processing speed. Multivariable linear regression was performed to assess the association of housing stability with changes in neurocognitive functioning between 6 and 24 months and to examine the effect of demographic and clinical variables on changes in neurocognitive functioning.Results: Overall neurocognitive impairment remained high over the study period (70% at 6 months and 67% at 24 months) with a small but significant improvement in the proportion of those experiencing more severe impairment (54% vs. 49% p < 0.002). Housing stability was not associated with any of the neuropsychological measures or domains examined; improvement in neurocognitive functioning was associated with younger age, and bipolar affective disorder at baseline.Conclusions: The high prevalence and persistence of overall neurocognitive impairment in our sample suggests targeted approaches to improve neurocognitive functioning merit consideration as part of health interventions to improve everyday functioning and outcomes for this population. Further efforts are needed to identify potential modifiable factors that contribute to improvement in cognitive functioning in homeless adults with mental illness.

NCOG-06. PILOT STUDY OF NEUROCOGNITIVE DECLINE IN MALIGNANT GLIOMA PATIENTS TREATED WITH CHEMORADIATION AND ADJUVANT CHEMOTHERAPY

Abstract The majority of glioma patients experience declines in neurocognitive function (NCF), presumably due to tumor and treatment effects. We sought to understand the natural history of this decline in grade III and grade IV patients. A condensed battery of cognitive tests (HTLV, COWAT, GPT, TMT, and BTA) was administered at three time points: prior (T0) and after (T1) chemoradiation, and during adjuvant chemotherapy (T2). 31 patients were enrolled of which 25, 9 grade III and 16 grade IV, were analyzed. Although our N was too small for statistically significant results, we observed potentially meaningful clinical trends. Changes in HTLV, TMT, and COWAT scores among grade III patients displayed a pattern different from that of grade IV, with a steep decline seen after chemoradiation (T0-T1) followed by improvement several months later (T1-T2), despite ongoing chemotherapy. Grade IV patients, in contrast, showed minimal decline in scores (little change in score between T0-T1 and between T1-T2), perhaps highlighting that NCF is more impacted by disease rather than treatment. We tried to identify a subset of patients who seemed more susceptible to NCF decline. Examination of key clinical features showed that less than gross total resection and less than 4 year degree education level trended to associate with steeper NCF decline (only 40% of those experiencing steep declines in multiple domains had more than 4 yr degree, versus 60% of those with moderate or no decline). This pilot study highlights that assessing neurocognitive function routinely in clinical practice is feasible in a rural academic hospital. Based on patterns of changes in NCF, it appears that grade III and grade IV gliomas are distinct tumor subtypes with respect to NCF decline. Level of education may be a useful biomarker to identify those patients most at risk for neurocognitive decline after treatment.

P1.16-40 Real-World Neurocognitive Function in Lung Cancer: Initial Results of the PRO-Long Study

Changes in neuro-cognitive function (NCF) as a result of treatment and disease have been repeatedly reported in cancer patients. However, contradictions exist on the prevalence and extent of impairment. Evidence in the lung cancer population is very limited. We here report the initial results of NCF in non-small cell lung (NSCLC) cancer patients receiving radiotherapy and/or systemic therapy in the PRO-Long study. PRO-Long is a monocentric, prospective, longitudinal study, investigating the effect of first-line chemotherapy, radiotherapy and/or immunotherapy on patient-reported health-related quality of life (HRQoL), toxicity, functional exercise capacity (6-minute walking test – 6MWT) and NCF in locally-advanced and metastatic NSCLC patients. HRQoL and toxicity data are collected with patient-reported outcome measurements (PROMs). NCF data is collected with the Reys-Osterrieth Complex Figure Test (ROCF), Hopkins Verbal Learning Test-Revidsed (HVLT-R) free recall, delayed recall and recognition; Trail Making Test (TMT) A and B, Controlled Oral Word Association Test (COWA), Wechsler Adult Intelligence Scale (WAIS) digit span and the Stroop Color and Word Test (SCWT). Demographic data are collected at baseline; outcome data (survival, local and loco-regional control and metastatic relapse) during follow-up. NCF data is collected pre-treatment, and 2-3 months, 6 and 12 months after the end of treatment in patients receiving chemo- and/or radiotherapy or after start of immunotherapy. The mixed model approach was applied to determine statistical significance (p < 0.05). Meaningful clinical important difference (MCID) in NCF is defined as a decline greater than one standard deviation from baseline. Between January 2016 and December 2018, 50 patients (mean age: 63) were recruited. The majority was male (60%), had locally-advanced disease (54%) and received chemotherapy with (50%) or without (24%) radiotherapy. NCF data is available of 49, 28, 16 and 10 patients at baseline, 2-3 months, 6 months and 1 year respectively. So far no significant decline was found in any NCF test. At 2-3 and 6 months after treatment, 42% and 34% of patients had a MCID decline in one or more tests. NCF decline was mostly detected in the HVLT-R free recall test, respectively 15 and 23% at 2-3 and 6 months. The initial data suggest that systemic treatment, all or not combined with radiotherapy may result in a clinically meaningful NCF decline in locally-advanced and metastatic NSCLC patients. Particularly, immediate recall seems to be affected. Updated results will be presented.

Impact attenuation of male and female lacrosse helmets using a modal impulse hammer

It has been established that substantial negative changes in neurocognitive function can be observed in a large percentage of athletes who participate in contact sports such as soccer or football, motivating a need for improved safety systems. Head accelerations in men’s lacrosse are similar to those in football and female lacrosse players experience high rates of concussions, necessitating better head protection in both sports. Previous studies have sought to evaluate the ability of modern football helmets to mitigate impacts both normal and oblique to the surface of the helmet using a system that quantifies both the input load and the resulting accelerations of a Hybrid III headform. This study quantifies the inputs and outputs of the helmet-Hybrid III headform system in order to compare the impact attenuation capability of two male and two female lacrosse helmets. Of those helmets tested, the better performing male helmet was the Schutt Stallion 650 and the better performing female helmet was the Hummingbird excepting device failure at the rear boss impact location, but football helmets still generally outperformed the lacrosse helmets tested here.

173. Preliminary Evidence for Changes in Neurocognitive Function After Adolescent Bariatric Surgery

173. Preliminary Evidence for Changes in Neurocognitive Function After Adolescent Bariatric Surgery

Head Impact Burden and Change in Neurocognitive Function During a Season of Youth Football.

To determine the association of repetitive subconcussive head impacts with functional outcomes in primary and high school tackle football players. Youth football fields and an outpatient sports neurology clinic. A total of 112 primary school (n = 55, age 9-12 years) and high school (n = 57, age 15-18 years) football players. A prospective cohort study. Helmet-based sensors were used to record head impacts during practices and games during the 2016 football season. Impact g-forces were summed to yield a measure of cumulative impact. History of self-reported premorbid medical diagnoses was obtained preseason. Players completed assessments of a variety of outcomes both pre- and postseason: neuropsychological test performance, symptoms, vestibular and ocular-motor screening, balance, parent-completed attention-deficit hyperactivity disorder (ADHD) symptoms, and self-reported behavioral adjustment. Average cumulative impact was 3700 (standard deviation = 2700) g-forces for the season and did not differ between age groups (P = .594). Cumulative impact did not predict pre- to postseason change scores on any outcome measures (all P > .05). Instead, younger age group and reported history of premorbid ADHD predicted change scores on several cognitive testing measures and parent-reported ADHD symptoms, while reported history of premorbid anxiety and depression predicted change scores on symptom reporting. In youth tackle football, subconcussive head impacts sustained over the course of a single season may not be associated with neurocognitive functional outcomes. The absence of a significant association may reflect the relatively short follow-up interval, and signals the need for studies across multiple seasons.

The Impact of Colloid Cyst Treatment on Neurocognition

Colloid cysts (CC) have been associated with neurocognitive function (NCF) decline, both preoperatively and after resection. Factors such as local pressure on the fornix and hydrocephalus are thought to contribute to preoperative NCF decline. The potential cause of postoperative decline is thought to be forniceal injury during surgery. In the current series, we describe NCF outcomes amongst patients with CC, both nonoperated and operated. A total of 36 patients (23 operated, 13 nonoperated) were included in this retrospective study. All patients underwent at least 1 NCF evaluation battery. Of the 13 nonoperated cases, 5 had follow-up tests too. Of the 23 operated, 14 had both pre- and postoperative tests, and 8 had early and late postoperative tests. There was no significant difference in baseline NCF between nonoperated and operated cases (as evaluated preoperatively). Nonoperated patients had a stable NCF test over time. Patients who were operated showed a significant improvement after surgery in several NCF variables. There was no significant change in NCF between early and late postoperative evaluation. None of the operated patients had a postoperative NCF decline. Patients with CC should undergo routine NCF testing with a standardized protocol, whether they are operated or followed. Surgery has a positive impact on NCF; however, it remains to be determined if the improvement is solely secondary to treatment of hydrocephalus, or to a reduction of local pressure on the fornices. It remains to be determined whether the surgical technique, that is, endoscopic, interhemispheric, or transcortical, has an impact on NCF outcome.

Influence of Residual Disease Following Surgical Resection in Newly Diagnosed Glioblastoma on Clinical, Neurocognitive, and Patient Reported Outcomes.

The influence of subtotal resection (STR) on neurocognitive function (NCF), quality of life, and symptom burden in glioblastoma is unknown. If bevacizumab preferentially benefits patients with STR is unknown. To examine these uncertainties. NCF and patient reported outcomes (PRO) were prospectively collected in NRG Oncology RTOG 0525 and 0825. Changes in NCF and PRO measures from baseline to prespecified times were examined by Wilcoxon test, and mixed effects longitudinal modeling, to assess differences between patients who received STR vs gross-total resection. Changes were also compared among STR patients on 0825 receiving placebo vs bevacizumab to assess for a preferential therapeutic effect. Overall survival between STR and gross-total resection patients was compared using the Kaplan-Meier method. A total of 427 patients were eligible with STR present in 37%. At baseline, patients with STR had worse NCF, worse MD Anderson Symptom Inventory Brain Tumor Neurological Factor ratings (P = .004), and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (P = .002). Longitudinal multivariate analysis associated STR with worse NCF (Hopkins Verbal Learning Test-Revised Delayed Recognition [P = .048], Trail Making Test Part A [P = .035], and Controlled Oral Word Association [P = .049]). One hundred eighty-three STR patients from 0825 were analyzed (89 bevacizumab, 94 placebo); bevacizumab failed to demonstrate improvement in select NCF or PRO measures. STR patients had worse NCF and PROs before therapy. During adjuvant therapy, STR patients had worse objective NCF, despite accounting for tumor location. STR did not result in a detriment to OS. The addition of bevacizumab did not preferentially improve PRO or NCF outcomes in STR patients.

Head impact burden and change in neurocognitive function over 2 seasons of youth football participation

ObjectiveTo determine the association of repetitive sub-concussive head impacts with neurocognitive outcomes in primary school and high school tackle football players.MethodsWe conducted a prospective cohort study of 35 primary school players age 9–12 and 20 high school players age 15–18 who each participated in 2 consecutive seasons of tackle football from 2016 to 2017. Helmet-based sensors were used to record head impacts during contact practices and games, which were summed as a cumulative impact for the 2 football seasons. Players were also divided into high intensity and low intensity groups based on whether they sustained high g-force impacts in both seasons. Players completed assessments on a variety of outcomes before the 2016 season and after the 2017 season: neuropsychological test performance, symptom ratings, vestibular-ocular function, balance, parent-completed ADHD symptoms, and self-reported behavioral adjustment.ResultsAverage cumulative impact was 6,920 (SD 4,553) g-forces combined for the 2 seasons and did not differ between age groups (p = 0.66). Twenty-one players (38%) were classified as high intensity based on individual impacts. After correcting for multiple comparisons, neither cumulative impact nor impact intensity predicted change scores from pre-2016 season to post-2017 season on any outcome measures. Instead, younger age group and history of ADHD predicted worse change scores on several cognitive measures and ADHD symptom reporting.ConclusionsOver 2 consecutive seasons of primary and high school tackle football participation, cumulative head impact burden and intensity of impacts were not found to be associated with changes in cognition, balance, vestibular-ocular function, or behavioral adjustment.

Effects of surgery on neurocognitive function in patients with glioma: a meta-analysis of immediate post-operative and long-term follow-up neurocognitive outcomes.

This study aims to identify the neuropsychological tests commonly used for assessment in each neurocognitive domain, and quantify the post-operative changes in neurocognitive function in the immediate post-operation and follow-up. With the use of the PubMed, a comprehensive search of the English literature was performed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. There were 1021 publications identified for screening. Standardized mean differences (SMD) in neuropsychological task performance were calculated both for immediate post-operation (up to 1week) and follow-up (up to 6months). Out of 12 studies which met the inclusion criteria, 11 studies were analyzed in this meta-analysis, with a total of 313 patients (age range 18-82, 50% males) with intracranial gliomas (45% high-grade, 55% low-grade). Complex attention, language and executive function were the most frequently tested neurocognitive domains. Surgery had a positive impact in the domains of complex attention, language, learning and memory tasks in the immediate post-operative period and sustained improvement at follow-up. In contrast, surgery was found to negatively impact performance for executive function in the immediate post-operative period with sustained decline in performance in the long term. This meta-analysis suggests that surgery for glioma confers a benefit for the domains of complex attention, language, learning and memory, while negatively affecting executive function, in the periods immediately after surgery and at 6 months follow-up. In addition, awake surgery seemed to confer a beneficial effect on neurocognitive functions. Future research should attempt to standardize a battery of neuropsychological tests for patients undergoing surgical resection for glioma, perhaps with a particular focus on executive function.

The correlation between longitudinal changes in hypothalamic-pituitary-adrenal (HPA)-axis activity and changes in neurocognitive function in mixed-state bipolar II disorder.

IntroductionIn this study, we aim to determine 1) the differences in cortisol in patients with bipolar II disorder (BD-II) and control subjects and 2) the correlation between cortisol levels and cognitive function in patients with BD-II during a 24-week follow-up period.MethodsWe recruited a total of 32 BD-II patients and 30 healthy control subjects. The BD-II patients were assessed for clinical severity and serum cortisol level at baseline and at weeks 8, 16, and 24. The Brief Assessment of Cognition in Affective Disorders (BACA) was adopted to evaluate cognitive function at baseline and endpoint (week 24). Meanwhile, we assessed the controls for serum cortisol level and BACA at baseline.ResultsWe observed that the BD-II group had a higher serum cortisol level and lower BACA composite scores compared with the healthy controls at baseline. A significant correlation was found between changes in Verbal Fluency, a subset of BACA, and changes in serum cortisol level after the 24-week follow-up, controlling for age, gender, years of education, and clinical severity (P<0.001).ConclusionWe propose that serum cortisol may be involved in the psychopathological mechanisms of cognitive decline in BD-II.

Long-term follow up of 3 T MRI-detected brain lesions after percutaneous catheter-based left atrial appendage closure.

Left atrial appendage closure (LAAC) for stroke prevention is an increasingly performed intervention. This prospective study aims to evaluate the incidence of long-term magnetic resonance imaging (MRI)-detected brain lesions as well as potential changes of neurocognitive function after percutaneous LAAC. Brain MRI at 3T was performed within 24hr before and after LAAC. A follow-up MRI was carried out after three months. Neuro-cognitive examination using the National Institutes of Health Stroke Scale (NIHSS) score and the Montreal Cognitive Assessment (MoCA) Test was performed. Successful device implantation was achieved in all 25 patients (age 74.6 ± 10.2 years, male = 17) using the Amulet (n = 20), Occlutech (n = 3), or a Lambre (n = 2) device. In 12/25 (48%) patients, acute brain lesions (ABL) were detected after LAAC. A three-month follow-up MRI was performed in seven patients, and no new ABLs were seen. In 5/7 (71%) patients, there were no residual changes from the ABLs detectable. However, the FLAIR sequence was still positive in two patients. After LAAC, there were no significant differences in the MoCA-test (mean 24.3 ± 4.5 vs. 23.5 ± 4.5; P = 0.1) and the NIHSS-score (mean 0.9 ± 1.6 vs. 1.2 ± 1.8; P = 0.1). This was the same at the three-month follow-up (MoCA-test 23.5 ± 4.5 vs. 23.8 ± 2.7; P = 0.3; NIHSS-score 1.2 ± 1.8 vs. 1.0 ± 0.8; P = 0.4). While new MRI-detected brain lesions are commonly observed after percutaneous LAAC, ABLs were no longer detectable in 71% of the patients at the three-month follow-up. There were no significant changes in neurocognitive function after LAAC and at the three-month follow-up.

Individual changes in neurocognitive functioning and health-related quality of life in patients with brain oligometastases treated with stereotactic radiotherapy

BackgroundRecently, it has been shown that at group level, patients with limited brain metastases treated with stereotactic radiotherapy (SRT) maintain their pre-treatment levels of neurocognitive functioning (NCF) and health-related quality of life (HRQoL). The aim of this study was to evaluate NCF and HRQoL changes over time at the individual patient level.MethodsNCF (seven domains assessed with a standardized test battery) and HRQoL (eight predetermined scales assessed with the EORTC QLQ-C30 and BN20 questionnaires) were measured prior to SRT and at 3 and/or 6 months follow-up. Changes in NCF and HRQoL were evaluated at (1) a domain/scale level and (2) patient level.ResultsA total of 55 patients were examined, of which the majority showed stable NCF 3 months after SRT, on both the domain level (78–100% of patients) and patient level (67% of patients). This was different for HRQoL, where deterioration in the different scales was observed in 12–61% of patients, stable scores in 20–71%, and improvement in 16–40%, 3 months after SRT. At patient level, most patients (64%) showed both improvement and deterioration in different HRQoL scales. Results were similar between 3 and 6 months after SRT.ConclusionIn line with results at group level, most brain oligometastases patients with ≥ 6 months follow-up and treated with SRT maintained their pre-treatment level of NCF during this period. By contrast, changes in HRQoL scores differed considerably at domain and patient level, despite stable HRQoL scores at group level.

Left atrial appendage angiography is associated with the incidence and number of magnetic resonance imaging–detected brain lesions after percutaneous catheter-based left atrial appendage closure

Percutaneous catheter-based left atrial appendage closure (LAAC) is a procedure being increasingly performed in patients with atrial fibrillation and high bleeding risk. The purpose of this study was to evaluate the incidence of magnetic resonance imaging (MRI)-detected acute brain lesions (ABLs) as well as potential changes in neurocognitive function after percutaneous LAAC in patients with atrial fibrillation. Brain MRI at 3 T was performed within 24 hours before and after LAAC along with neurologic (National Institutes of Health Stroke Scale [NIHSS] score) and cognitive (Montreal Cognitive Assessment [MoCA] test) assessment. Acquired MRI sequences included high-resolution diffusion-weighted imaging as well as fluid-attenuated inversion recovery. Successful device implantation was achieved in all 23 patients (age 74.1 ± 10.5 years; 16 male) using the Amulet (n=18), Occlutech (n = 3), or LAmbre (n = 2) device. Thirty-seven ABLs were detected by MRI in 12 of 23 patients (52%) after LAAC. The number of periprocedural LAA angiographies was significantly higher in patients with ABL than in those without ABL (1.67 ± 0.65 vs 1.18 ± 0.41; P = .048) and was associated with a higher number of ABL (ρ = 0.615; P = .033). Compared to pre-LAAC assessment, post-LAAC MoCA and NIHSS scores revealed similar results. After LAAC, MoCA test (mean 24.1 ± 4.6 vs 23.2 ± 4.6; P=.09) and NIHSS score (mean 1.0 ± 1.7 vs 1.2 ± 1.8; P = .1) were similar between patients with and those without ABL, respectively. MRI-detected ABLs are commonly observed after percutaneous LAAC. The number of LAA angiographies is significantly associated with the number of ABLs; however, the clinical implications of ABL have yet to be determined.

Assessments of neurocognitive and behavioral function in the mucopolysaccharidoses.

The mucopolysaccharidoses (MPS) are a group of rare, inherited lysosomal storage disorders in which accumulation of glycosaminoglycans (GAGs) leads to progressive tissue and organ dysfunction. In addition to a variety of somatic signs and symptoms, patients with rapidly progressing MPS I (Hurler), II, III, and VII can present with significant neurological manifestations, including impaired cognitive abilities, difficulties in language and speech, behavioral abnormalities, sleep problems, and/or seizures. Neurological symptoms have a substantial impact on the quality of life of MPS patients and their families. Due to the progressive nature of cognitive impairment in these MPS patients, neurocognitive function is a sensitive indicator of disease progression, and a relevant outcome when testing efficacy of therapies for these disorders. In order to effectively manage and develop therapies that address neurological manifestations of MPS, it is important to use appropriate neurocognitive assessment tools that are sensitive to changes in neurocognitive function in MPS patients. This review discusses expert opinions on key issues and considerations for effective neurocognitive testing in MPS patients. In addition, it describes the neurocognitive assessment tools that have been used in clinical practice for these patients. The content of this review is based on existing literature and information from a meeting of international experts with extensive experience in managing and treating MPS disorders.

A Prospective Evaluation on the Effects of One High School Football Season on Neurocognitive Test Scores in High School Football Athletes

Subconcussive head impacts do not result in outward signs of neurological dysfunction, however they may have an effect on neurocognitive function. Limited research has indicated that negative changes in neurocognitive function occurs in high school football athletes as a result of one season of football. The purpose of this study was to prospectively evaluate the effects of one season of high school football on neurocognitive test scores. Results revealed a significant group and time interaction effect (p &lt; .001) for the Verbal Memory composite score of the ImPACT test. Further analysis revealed a significant difference in the Verbal Memory score between groups at postseason (p &lt; .01), with the football group scoring lower than the low contact group. It appears that one season of high school football may have a negative effect on the Verbal Memory composite score of the ImPACT test in high school football athletes.