Cognitive Changes In Patients Research Articles

Dural Arteriovenous Fistulas: Baseline Cognitive Changes and Changes following Treatment: A Prospective Longitudinal Study.

Dural arteriovenous fistulas (DAVFs) exhibit varied clinical manifestations, and high-grade cases are associated with both a risk of hemorrhage and (in certain cases) dementia. Less known, however, is the association between DAVF and more subtle cognitive changes, which might not be clinically apparent without formal neurocognitive testing. This study prospectively assesses baseline cognitive changes in patients with unruptured DAVFs and looks at the effects of treatment on any such changes. A longitudinal prospective study was conducted to formally evaluate the neurocognitive status of patients with unruptured DAVFs undergoing embolization. Pre- and posttreatment assessments included neurologic examinations and cognitive tests (Repeatable Battery for the Assessment of Neuropsychological Status and Trail-Making Test [TMT]). A total of 23 patients were treated, with 78% demonstrating cortical venous reflux at baseline. At baseline, 50% of patients demonstrated cognitive impairment in at least 1 cognitive domain, and this was significantly associated with cortical venous reflux (P < .05). Following treatment, significant improvements were observed in several cognitive domains. The mean change in Immediate Memory was an increase of 10.5 points (95% CI, 6.2-14.8, P < .001). Visuospatial/Constructional abilities showed a mean increase of 3.8 points (95% CI, 1.1-6.5, P = .008), while Language improved by a mean of 4.2 points (95% CI, 0.9-7.5, P = .015). Attention scores increased by a mean of 6.1 points (95% CI, 2.7-9.5, P < .001). Delayed Memory demonstrated a mean improvement of 7.4 points (95% CI, 3.5-11.3, P < .001), and the Total Repeatable Battery for the Assessment of Neuropsychological Status Score increased by a mean of 8.6 points (95% CI, 5.0-12.2, P < .001). For the TMT, the mean change in TMT-A was a decrease of 9.2 seconds (95% CI, 5.6-12.8, P < .001), indicating faster completion times. TMT-B scores decreased by a mean of 12.7 seconds (95% CI, 8.4-17.0, P < .001). The TMT B-A difference decreased by a mean of 3.5 seconds (95% CI, 0.5-6.5, P = .023), and the TMT B/A ratio showed a mean decrease of 0.18 (95% CI, 0.10-0.26, P = .002). Overall, among the patients with baseline cognitive impairment, 70% showed significant cognitive improvement following endovascular treatment, particularly in memory domains. In our study, 50% of patients with DAVFs had cognitive impairment when assessed with formal neurocognitive testing, with a significant link to cortical venous reflux. This cognitive impairment improved in 70% of those patients following treatment. These findings expand our understanding of how DAVF affects the brain, highlighting cognitive impairment as a critical factor. Consequently, the treatment of DAVFs should perhaps not only focus on hemorrhagic risk but also consider cognitive outcomes as a potential indicator for intervention.

Identifying older adults at risk for dementia based on smartphone data obtained during a wayfinding task in the real world.

Alzheimer's disease (AD), as the most common form of dementia and leading cause for disability and death in old age, represents a major burden to healthcare systems worldwide. For the development of disease-modifying interventions and treatments, the detection of cognitive changes at the earliest disease stages is crucial. Recent advancements in mobile consumer technologies provide new opportunities to collect multi-dimensional data in real-life settings to identify and monitor at-risk individuals. Based on evidence showing that deficits in spatial navigation are a common hallmark of dementia, we assessed whether a memory clinic sample of patients with subjective cognitive decline (SCD) who still scored normally on neuropsychological assessments show differences in smartphone-assisted wayfinding behavior compared with cognitively healthy older and younger adults. Guided by a mobile application, participants had to find locations along a short route on the medical campus of the Magdeburg university. We show that performance measures that were extracted from GPS and user input data distinguish between the groups. In particular, the number of orientation stops was predictive of the SCD status in older participants. Our data suggest that subtle cognitive changes in patients with SCD, whose risk to develop dementia in the future is elevated, can be inferred from smartphone data, collected during a brief wayfinding task in the real world.

Brain and cognitive changes in patients with long COVID compared with infection-recovered control subjects.

Between 2.5% and 28% of people infected with SARS-CoV-2 suffer long COVID or persistence of symptoms for months after acute illness. Many symptoms are neurological, but the brain changes underlying the neuropsychological impairments remain unclear. This study aimed to provide a detailed description of the cognitive profile, the pattern of brain alterations in long COVID and the potential association between them. To address these objectives, 83 patients with persistent neurological symptoms after COVID-19 were recruited, and 22 now healthy control subjects chosen because they had suffered COVID-19 but did not experience persistent neurological symptoms. Patients and controls were matched for age, sex and educational level. All participants were assessed by clinical interview, comprehensive standardized neuropsychological tests and structural MRI. The mean global cognitive function of patients with long COVID assessed by Addenbrooke's Cognitive Examination-III screening test [overall cognitive level (OCLz) = -0.39 ± 0.12] was significantly below the infection recovered-controls (OCLz = +0.32 ± 0.16, P < 0.01). We observed that 48% of patients with long COVID had episodic memory deficit, with 27% also with impaired overall cognitive function, especially attention, working memory, processing speed and verbal fluency. The MRI examination included grey matter morphometry and whole brain structural connectivity analysis. Compared to infection recovered controls, patients had thinner cortex in a specific cluster centred on the left posterior superior temporal gyrus. In addition, lower fractional anisotropy and higher radial diffusivity were observed in widespread areas of the patients' cerebral white matter relative to these controls. Correlations between cognitive status and brain abnormalities revealed a relationship between altered connectivity of white matter regions and impairments of episodic memory, overall cognitive function, attention and verbal fluency. This study shows that patients with neurological long COVID suffer brain changes, especially in several white matter areas, and these are associated with impairments of specific cognitive functions.

Interaction between Aβ and tau on reversion and conversion in mild cognitive impairment patients: After 2-year follow-up

BackgroundThe role of amyloid-β (Aβ) and tau in reversion and conversion in patients with mild cognitive impairment (MCI) remains unclear. This study aimed to investigate the influence of cerebrospinal fluid (CSF) Aβ and tau on reversion and conversion and the temporal sequence of their pathogenicity in MCI patients. Methods179 MCI patients were recruited from the Alzheimer's Disease Neuroimaging Initiative database and classified into two groups based on cognitive changes after follow-up: reversal group (MCI to cognitively normal) and conversion group (MCI to Alzheimer's disease). CSF biomarkers and cognitive function were measured at baseline and 2-year follow-up. Partial correlation was used to analyze the association between CSF biomarkers and cognitive function, and multivariable logistic regression to identify independent risk factors for cognitive changes at baseline and 2-year follow-up. Receiver operating characteristic (ROC) curves were utilized to evaluate the predictive ability of these risk factors for cognitive changes. ResultsThe differences in cognitive function and CSF biomarkers between the two groups remained consistent with baseline after 2-year follow-up. After controlling for confounding variables, there was still a correlation between CSF biomarkers and cognitive function at baseline and 2-year follow-up. Multivariable regression analysis found that at baseline, only Aβ level was independently associated with cognitive changes, while Aβ and tau were both predictive factors after 2-year follow-up. ROC curve analysis revealed that the combination of Aβ and tau [area under the curve (AUC) 0.91, sensitivity 84%, specificity 86%] in predicting cognitive changes after 2-year follow-up had better efficacy than baseline Aβ alone (AUC 0.81). ConclusionAβ may precede Tau in causing cognitive changes, and the interaction between the two mediates cognitive changes in patients. This study provides new clinical evidence to support the view that Aβ pathology precedes tau pathology, which together contribute to the changes in cognitive function.

Functional and Neuropsychological Outcome After Surgical Treatment of Moyamoya Disease

IntroductionMoya Moya disease(MMD) is a rare cerebrovascular disease characterized by progressive stenosis of the supraclinoid ICA. Due to chronically decreased brain perfusion, eloquent areas of the brain become hypo-perfused leading to cognitive changes in patients. Repeated infarcts and bleeds produce clinically apparent neurological deficits. Aim and Objective1) To study the functional and neuropsychological outcome in Moya Moya Disease following revascularization surgery.2) To find post revascularisation correlation between functional and neuropsychological improvement and radiological improvement. Material and methodA single-center prospective and analytical study including 21 patients of MMD during the study period from March 2021 to December 2022. Patients were evaluated and compared in the pre-and post-revascularization for functional, neuropsychological, and radiological status. ResultPost-operative functional outcome in terms of modified Rankin Score showed improvement in 33.33% of cases (p-value = 0.0769). An overall improving trend was observed in different neuropsychological domains in both adult and pediatric age groups. But, the trend of neuropsychological improvement was better in adults as compared to the pediatric patients. Radiological outcome in the forms of the Angiographic Outcome Score (AOS) significantly improved after post-revascularization (p-value = 0.0001). There was a trend towards improvement in MRI perfusion in the MCA and ACA territories, 4.7% (p-value=0.075) and 9.33% (p-value-0.058) respectively, as compared to preoperative MRI perfusion. ConclusionsPost revascularisation, significant improvement occurred in functional and neuropsychological status. This was also demonstrated radiologically as evident by improvement in MRI perfusion and cerebral angiography.

Associations of Orthostatic Hypotension and Orthostatic Intolerance with Domain-Specific Cognitive Decline in Patients with Early Parkinson Disease: An 8-Year Follow-up

ObjectiveAlthough orthostatic hypotension (OH) and orthostatic intolerance (OI) are prevalent in patients with Parkinson disease (PD), it remains unclear how these conditions primarily affect the trajectory of decline in specific cognitive domains. This study aimed to explore the effects of OH and OI on longitudinal domain-specific cognitive changes in patients with PD. DesignAn 8-year follow-up of the Parkinson Progression Markers Initiative cohort study. Setting and ParticipantsA total of 403 patients with early, untreated PD and 195 matched healthy controls were included. They were classified into OH, OI, and normal groups. OH was defined according to the international consensus, and OI was defined as the presence of orthostatic symptoms without meeting the criteria for OH. MethodsThe patients underwent detailed neuropsychological testing annually for up to 8 years of follow-up. Linear mixed effects models were used to investigate the associations between OH, OI, and longitudinal cognitive changes. ResultsThe prevalence of both OH and OI in patients with PD was significantly higher than that in controls (13.4% vs 7.2%, P = .002, for OH, and 29.3% vs 14.4%, P < .001, for OI). The OH group in patients with PD showed a faster decline in Letter-Number Sequencing (LNS) (β = −0.11, 95% CI −0.20 to −0.02, t = −2.44, P = .015) and Semantic Fluency Test (SFT) (β = −0.44, 95% CI –0.81 to −0.08, t = −2.42, P = .016) scores than the normal group. Similarly, the OI group showed a steeper decline in LNS (β = −0.08, 95% CI –0.14 to −0.01, t = −2.20, P = .028) and SFT (β = −0.36, 95% CI –0.63 to −0.08, t = −2.55, P = .011) scores compared to the normal group. There were no significant longitudinal changes in the other neuropsychological test scores between the groups. Conclusions and ImplicationsBoth OH and OI may be associated with a faster decline in executive function among cognitive domains of patients with PD. These findings may highlight the potential importance of orthostatic blood pressure control in PD patients with OH and even those with orthostatic symptoms without OH.

Neurocognitive Disorders in COVID-19 Patients: Controversed and Unresolved Issues

New Coronavirus Infection (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2). Since 2019, a large number of studies on cognitive impairment in the background of COVID-19 have emerged, and “long COVID” is among them. A non-systematic review based on 2019-2022 studies provides information on the severity of cognitive changes in patients with COVID-19, diagnostic methods that can detect these cognitive impairment and long-term neuropsychiatric and cognitive outcomes that may pose a serious public health challenge.

Abnormalities in modular connectivity of functional brain networks and cognitive changes in patients with anti -N-methyl-D-aspartate receptor encephalitis

ObjectiveTo explore potential mechanisms of cognitive changes in patients with anti-NMDAR encephalitis (ANMDARE) from intramodule and intermodule effects of brain functional networks. MethodsResting-state functional MRI(rs-fMRI) imaging data was collected from 30 ANMDARE and 30 healthy controls (HCs). A brain functional matrix was constructed, and sparsity was established by module similarity. For both groups, changes in functional connectivity (FC) within and between modules was calculated, and whole-brain functional topology was analyzed. Finally, the association of brain functional with cognitive function in ANMDARE was further analyzed. ResultsCompared to HCs, ANMDARE had enhanced connectivity within the modules that included the occipito-parietal-temporal and parahippocampal gyri. ANMDARE had significantly higher participation coefficients (PC) in the right inferior frontal gyrus than HCs and significantly lower PC in the left superior parietal lobule, left caudate nucleus, and right putamen. No statistically significant differences in global topological properties were found between the two groups. No correlations were found between functional and structural brain indicators and the Cognitive Assessment Scale and the Emotional Deficit Scale. ConclusionsPatients with ANMDARE are manifested by enhanced intramodular FC and intermodular connectivity changes in the brain. This may help to understand the pathophysiological mechanisms of the disease from a global perspective.

Predictors of cognitive changes in patients with schizophrenia undergoing electroconvulsive therapy.

Previous studies on the effects of electroconvulsive therapy (ECT) on cognition in schizophrenia have been inconclusive. This study aimed to identify factors that may predict cognitive improvement or deterioration in patients with schizophrenia after-ECT. Patients with schizophrenia or schizoaffective disorder with predominantly positive psychotic symptoms, who were treated with ECT at the Institute of Mental Health (IMH), Singapore, between January 2016 and January 2018, were assessed. Montreal Cognitive Assessment (MoCA), Brief Psychiatric Rating Scale (BPRS) and Global Assessment of Function (GAF) were performed before and after ECT. Patients with clinically significant improvement, deterioration or no change in MoCA scores were compared on demographics, concurrent clinical treatment and ECT parameters. Of the 125 patients analysed, 57 (45.6%), 36 (28.8%) and 32 (25.6%) showed improvements, deterioration and no change in cognition respectively. Age and voluntary admission predicted MoCA deterioration. Lower pre-ECT MoCA and female sex predicted MoCA improvement. Patients showed improvements in GAF, BPRS and BPRS subscale scores on average, except for the MoCA deterioration group, who did not show statistically significant improvement in negative symptom scores. Sensitivity analysis showed that nearly half the patients (48.3%) who were initially unable to complete MoCA pre-ECT were able to complete MoCA post-ECT. The majority of patients with schizophrenia demonstrate improved cognition with ECT. Patients with poor cognition pre-ECT are more likely to see improvement post-ECT. Advanced age may be a risk factor for cognitive deterioration. Finally, improvements in cognition may be associated with improvements in negative symptoms.

Effects of weight loss on cognitive function in patients with diabetes: A systematic review and meta-analysis

AimsNormalization of body weight is a treatment objective for diabetes. Therefore, anti-diabetic drugs that cause weight loss are widely used in clinics, with the aim of reducing the risk of chronic complications. However, the effect of weight loss on cognition in patients with diabetes is unclear. MethodsEmbase, the Cochrane Library, PubMed, and the Web of Science were searched systematically, without study type restrictions, from inception to December 18, 2022. Weight loss was defined as a statistically significant decrease in body mass index (BMI) following an observation or intervention. We conducted an analysis of pooled data using a random-effects model. ResultsA total of 619 participants in five studies were included. Weight loss was not associated with cognitive changes in patients with diabetes (standardized mean difference 0.50, 95% confidence interval −0.09 to 1.08). Subgroup analyses showed that this was not significantly affected by the duration of intervention or observation, or the size of the reduction in BMI. However, it was challenging to draw definitive conclusions regarding the effects of interventions and baseline BMI, because only one study was included. ConclusionsWeight loss may be neutral to cognitive function in diabetes, but further studies are required to draw more definitive conclusions.

Longitudinal cognitive changes in patients with early Parkinson's disease and neuropsychiatric symptoms.

In this study, we aimed to investigate the effect of neuropsychiatric symptoms (NPS) on the rate of cognitive decline for both global cognition and specific cognitive domains in a cohort of patients from the Parkinson's Progression Markers Initiative (PPMI). Prospectively longitudinal data were obtained from the PPMI cohort. NPS, including depression, anxiety, apathy, psychosis, impulse control disorders (ICDs), and cognition ability, were evaluated by a series of questionnaires. Linear mixed-effects models were used to investigate the relationship between NPS and the rate of cognitive decline. Generalized estimating equations (GEEs) were used to investigate the relationship between NPS and the occurrence of mild cognitive impairment (MCI). In total, 423 patients with Parkinson's disease (PD) were recruited at baseline and 395, 378, 366, 346, and 315 participants were followed up at 1, 2, 3, 4, and 5 years, respectively. Depression, anxiety, apathy, and psychosis were associated with global cognitive decline. Except for those with ICDs, patients with psychosis, depression, anxiety, and apathy were more likely to meet the criteria for MCI. Patients with depression and anxiety showed a progressive decline in four major cognitive domains. Apathy and ICDs were separately associated with a progressive decline in processing speed-attention and memory, respectively. Neuropsychiatric symptoms, including psychosis, depression, anxiety, and apathy, could be used to predict future cognitive decline in patients with PD.

Cognitive Dysfunction, an Increasingly Valued Long-Term Impairment in Acromegaly.

Acromegaly is a chronic disease caused by the overproduction of growth hormone (GH) and accompanying insulin-like growth factor-1 (IGF-1), which is often caused by GH-secreting pituitary adenomas. In addition to its somatic burden, a growing number of studies have found that patients suffering from acromegaly exhibit psychosocial and personality changes. Over the past 70 years, there has been increasing interest in the cognitive impairment and neuropsychological issues of patients with acromegaly, and a variety of neuropsychological and neurophysiological tests have been used to measure cognitive changes in patients. The impact of disease progression status, treatment modalities, and various comorbidities on cognitive function and the mechanisms of cognitive impairment in patients with acromegaly are therefore outlined in this review. Multidisciplinary assessment has important implications for the management of acromegaly, particularly in relation to cognitive function. Here, we summarize the relevant literature concerning cognitive-behavioral research on acromegaly to demonstrate the impact of long-term impairment caused by GH and IGF-1 on the cognitive behavior of patients.

Cognitive and neuroimaging outcomes in individuals with benign and low-grade brain tumours receiving radiotherapy: a protocol for a prospective cohort study

IntroductionRadiation-induced cognitive decline (RICD) occurs in 50%–90% of adult patients 6 months post-treatment. In patients with low-grade and benign tumours with long expected survival, this is of paramount importance. Despite...

Do Sex Differences Exist in Cognitive Function in Patients with Atrial Fibrillation?

AbstractBackgroundAtrial fibrillation (AF) is a risk factor for mild cognitive impairment (MCI) and dementia. To address sex differences in AF‐related MCI, we examined disease prevalence and progression among adults with and without AF in the National Alzheimer’s Coordinating Center (NACC) cohort.MethodData freeze/extraction of NACC data (N = 43,746) took place March 2021. Participants with ≥ 3 annual visits, diagnostic data, and AF status (self‐reported or diagnosed) were included. Diagnostic categories were normal, MCI, and dementia. Multinomial logistic regression and Cox proportional hazard model were used to examine association between AF and baseline cognitive diagnosis and time to progression in cognitive diagnosis, respectively. Covariates included age, sex, race, education, BMI, smoking, depression, hypertension, diabetes, hypercholesterolemia, heart failure, stroke, and sleep apnea. Interactions with sex were examined in all models.Result4,593 participants had AF at baseline (46% female, mean age 78.5 years, 81% White, 8% Black, 11% other ethnicities). AF is associated with higher odds of having MCI (OR 3.43 [1.48, 7.91] in females; OR 1.73 [0.81, 3.71] in males) and dementia (OR 3.00 [1.22, 7.38] in females; OR 2.60 [1.16, 5.81] in males) at baseline. Among the 13,683 subjects included in the survival analysis, 4066 (30%) progressed from normal cognition to MCI and 2895 (21%) developed dementia (2434 [18%] AD) with median follow‐up of 4 years. Women with AF had higher risk of disease progression (HR 1.21 [1.04, 1.40]) compared to women without AF, but the association was not significant in men (HR 0.96 [0.83, 1.11]). AF was significantly associated with faster transition from normal cognition to MCI (HR 1.17 [1.03, 1.33]) and from MCI to vascular dementia (HR 2.51 [1.63, 3.85]) but not MCI to AD.ConclusionThis is the first study to examine sex differences in rate of cognitive change in patients with AF. Women with AF are at higher risk of MCI and dementia with more rapid trajectories to dementia than women without AF or men with or without AF. Identification of those at highest risk of cognitive decline will inform future interventions to prevent or slow AF‐related MCI and AD.

Memory decline in young stroke survivors during a 9-year follow-up: A cohort study.

A decade after stroke, young stroke survivors continue to suffer from cognitive impairment. However, it is not known whether this long-term cognitive outcome is caused in part by further cognitive decline or solely by incomplete recovery from the acute effects of ischemic stroke. We studied changes in three cognitive domains over a 9-year follow-up period after first-ever and only ischemic stroke. In this prospective, two-center cohort study, we recruited consecutive 18-65 year-old patients with acute stroke between 2007 and 2009, along with demographically matched stroke-free controls. We performed comprehensive neuropsychological assessments at 3 months, 2, and 9 years after stroke, and we also performed neurological examinations at the time of inclusion and at the 9-year follow-up. We assessed the associations among stroke, follow-up time and long-term cognitive outcomes using repeated-measures analysis of variance. The subjects comprised 85 patients who had had their first-ever and only ischemic stroke (mean age 53 years at inclusion), along with 31 stroke-free demographic controls. We compared the cognitive changes in patients to those in controls over a 9-year follow-up. After initial recovery between 3 months and 2 years after stroke, patients showed a decline in memory between 2 and 9 years after stroke compared to controls within the same time interval (immediate recall p < 0.001; delayed recall p < 0.001; list learning p < 0.001). Other than memory, we found no difference in cognitive changes between poststroke patients and controls. Our main finding was memory decline over a decade in young first-ever stroke patients with no further stroke or neurodegenerative disease. Our study extends the previous results of further memory decline in elderly stroke survivors to young stroke survivors. Young stroke survivors might be at risk of memory decline over the decade following the stroke.

Improved executive function in patients with systemic lupus erythematosus following interactive digital training.

This study aimed to evaluate the sensitivity of a digital platform to assess attentional and executive function in systemic lupus erythematosus (SLE) patients, and to evaluate the impact of an at-home interactive digital treatment to improve cognitive dysfunction in this clinical population. Deficits in attention and executive function are common in patients with SLE. Despite these cognitive difficulties, there are limited brief assessment techniques and few treatment options to improve cognitive abilities in patients with SLE. Interactive digital treatment approaches (use of video game-based software) have been successful in identifying and improving cognition in other clinical populations. Sixty SLE patients completed baseline neuropsychological tests (of attention, psychomotor speed, and executive function), a tablet-based digital platform (EVOTM Monitor), and biobehavioral measures. The patients were randomized into treatment SLE (n = 30) or no contact control SLE (n = 30) groups, and returned 4weeks later for follow-up cognitive, EVO Monitor, and biobehavioral testing. The SLE treatment group was trained on a tablet-based digital treatment (AKL-T01) and was instructed to complete 5 sessions at least 5days per week for 4-weeks for a total of approximately 25min of gameplay per day. Systemic lupus erythematosus patients demonstrated impairment in visuomotor and processing speed, visual attention, and cognitive flexibility/sequencing skills at baseline. The video game-like treatment group (AKL-T01) had significant improvement in visuomotor speed (Trail Making A) and cognitive flexibility/sequencing (Trail Making B) compared to the control group at 4-week follow-up. The treatment group also demonstrated significant improvement in EVO Monitor multitasking at follow-up (with no change in controls). At baseline, a multitasking metric from EVO Monitor was associated with performance on tasks of cognitive flexibility (Trail Making B) and psychomotor speed (WAIS-IV Coding). These findings provide evidence that SLE patients who participated in a 4-week interactive digital video game-like activity had significant improvement in motor speed and executive functions, and would benefit from participation in digital interventions designed to target frontoparietal networks of the brain. Preliminary findings also suggest specific metrics from EVO Monitor may also be useful to detect cognitive impairment and cognitive changes in patients with SLE.

Infarct location and cognitive change in patients after acute ischemic stroke: The ICONS study

Background and purposePost stroke cognitive impairment is closely related to the quality of life. We aimed to evaluate the association between infarct location and cognitive change over time after acute ischemic stroke (AIS). MethodsPatients were selected from the Impairment of Cognition and Sleep after AIS or transient ischemic attack in Chinese patients (ICONS) study. Infarct location was assessed by brain magnetic resonance imaging. Cognition was screened at two weeks and 12 months by the Montreal Cognitive Assessment (MoCA). The primary outcome was the cognitive change at 12 months compared to two weeks. We tested the associations with cognitive change using logistic regression analysis. ResultsA total of 865 patients were enrolled. The mean age of the study participants was 59.67 ± 10.92 years, and the median National Institutes of Health Stroke Scale was 3 (1–5). In a fully adjusted model, thalamic infarction was significantly associated with cognitive decline after 12 months following an AIS (odds ratio [OR] 4.873, 95% confidence interval [CI] 1.634–14.534; p = 0.005), independent of stroke etiology (p > 0.05). ConclusionsThalamic infarction increased the risk of worse cognitive performance, as screened by MoCA in relatively young patients with minor ischemic stroke at 12 months, suggesting the thalamus may be a critical structure in preserving cognition after stroke.

Possibilities of brain SPECT with perfusion radiopharmaceuticals for the quantitative assessment of cognitive changes in patients with hypertensive encephalopathy

Background. Vascular diseases of the brain, which lead to encephalopathy, are a significant medical and social problem. The main clinical tool for diagnosing cognitive impairments is a neuropsychological testing. Its disadvantages are a big number of different tests, which are used in clinical institutions, and thus, make it extremely complicated to compare the data; in monitoring studies, patients can learn answers, which somewhat distorts the results; there is also a possibility of a non-objective doctor’s impact on the results of the conducted test. Therefore, the development of methods for assessing the neuropsychological and cognitive state of patients based on objective data is an urgent task. Besides, to this date, it is not completely known which segments of the brain directly or indirectly affect this or that cognitive function. Purpose – to develop a methodology for assessing the scores of neuropsychological testing (NPT) in patients with atherosclerotic hypertensive encephalopathy (ATHE) based on data from single-photon emission computed tomography (SPECT) with perfusion radiopharmaceuticals (RPh). Materials and Methods. NPT and SPECT data of twenty patients with clinical diagnosis of atherosclerotic hypertensive encephalopathy were analyzed. The principal scales used during the study were the following: Montgomery – Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HARS), Schulte Table, O. Luria. Tomographic images of the brain were obtained on the gamma camera «E. Cam» (Siemens) using perfusion lipophilic radiopharmaceutical 99mTc-hexamethylpropyleneamineoxime (99mTc-HMPAO). Processing and analysis of the scintigraphic images were conducted in the original software «ScintiBrain», which is implemented in the Matlab-2018 environment. The quantitative characteristics of accumulation and spatial distribution of RPh in the brain were: specific accumulation of RPh (Upt) and parameter of intrahemispheric symmetry (IHS) of perfusion in the brain segments. Based on machine learning method, which can be attributed to regression methods, NPT data were compared with the ratio of Upt and IHS between different segments of the brain Results. As a result of the analysis (machine learning) of 190 Upt and IHS ratios between different segments of the brain with NPT values, the most informative ratios in terms of regression analysis were highlighted. The independence of Upt and IHS makes it possible to increase the accuracy of calculations of NPT values by algebraic averaging of calculations by Upt and IHS ratios.&#x0D; Machine learning results by both Upt and IHS values had one order of correlation and a mean squared error in the tests. The correlation coefficient of linear approximation of values between the SPECT and NPT data was in the range of 0.75–0.93 (p &lt; 0.01), which corresponded to the average relative error in calculations of test values from 7–22%. Conclusions. For the first time, a method of quantitative assessment of the neuropsychological and cognitive state of patients was developed on the basis of an objective research method, namely SPECT. The average relative error in calculations of equivalent values of NPT was in the range of 7 – 22%. At the same time, it was shown that the neuropsychological and cognitive state of patients, in particular patients with ATHE, according to the analysis of effective brain perfusion, didn’t correspond to one specific segment of the brain, but instead to a group of three interrelations of RPh accumulation in the highlighted regions of interest. The presence of a sufficiently high correlation between the NPT data and the indicators of the specific accumulation of RPh and the IHS in the brain segments showed that the neuropsychological and cognitive state of the patient depended not only on the level of accumulation of RPh in segments, but also on its spatial distribution.

Enhancement of Impaired Olfactory Neural Activation and Cognitive Capacity by Liraglutide, but Not Dapagliflozin or Acarbose, in Patients With Type 2 Diabetes: A 16-Week Randomized Parallel Comparative Study

The comparative neuroprotective effects of different antidiabetes drugs have not been characterized in randomized controlled trials. Here, we investigated the therapeutic effects of liraglutide, dapagliflozin, or acarbose treatment on brain functional alterations and cognitive changes in patients with type 2 diabetes. Thirty-six patients with type 2 diabetes inadequately controlled with metformin monotherapy were randomized to receive liraglutide, dapagliflozin, or acarbose treatment for 16 weeks. Brain functional MRI (fMRI) scan and a battery of cognitive assessments were evaluated pre- and postintervention in all subjects. The 16-week treatment with liraglutide significantly enhanced the impaired odor-induced left hippocampal activation with Gaussian random field correction and improved cognitive subdomains of delayed memory, attention, and executive function (all P < 0.05), whereas dapagliflozin or acarbose did not. Structural equation modeling analysis demonstrated that such improvements of brain health and cognitive function could be partly ascribed to a direct effect of liraglutide on left hippocampal activation (β = 0.330, P = 0.022) and delayed memory (β = 0.410, P = 0.004) as well as to the metabolic ameliorations of reduced waist circumference, decreased body fat ratio, and elevated fasting insulin (all P < 0.05). Our head-to-head study demonstrated that liraglutide enhanced impaired brain activation and restored impaired cognitive domains in patients with type 2 diabetes, whereas dapagliflozin and acarbose did not. The results expand the clinical application of liraglutide and provide a novel treatment strategy for individuals with diabetes and a high risk of cognitive decline.

Advances in Cognitive Remediation Training in Schizophrenia: A Review.

Cognitive Remediation Training (CRT) in schizophrenia has made great strides since its introduction in the 1990s. CRT was developed with the aim of improving the everyday functioning of individuals living with cognitive impairment. MEDLINE, PsychINFO, and Google Scholar were searched to extract peer-reviewed randomized controlled trials to produce the current review article. The aim of the present review is to summarize CRT effects on addressing cognitive changes in patients undergoing CRT as defined by the Cognitive Remediation Experts Workshop and to describe the areas of greatest impact in specific cognitive domains. Another area of this review aims to summarize the modalities of intervention (paper and pencil; computerized; home bound), the persistence of improvements, and their generalization to other domains of functioning. Finally, this review delineates barriers for wider dissemination of CRT, such as the transfer of research findings into clinical everyday practice and future developments of CRT.