Cognitive Disturbances In Patients Research Articles

The Translation and Psychometric Evaluation of the Persian Version of the Neuropsychological Vertigo Inventory

Background and Aim: Experiencing dizziness/vertigo is often an indication of dysfunction in the vestibular system. Recent findings show a connection between peripheral vestibular dysfunction and cognitive impairments. The Neuropsychological Vertigo Inventory (NVI) can assess physical, emotional, and cognitive issues in individuals with dizziness/vertigo. The aim of this research was to translate, cultural adaptation and evaluation of the reliability and validity of NVI to Persian. Methods: In this descriptive-analytical study, the NVI scale was translated and adapted to the Iranian cultural context following the international quality of life assessment protocol for translation and equivalence. After obtaining face validity, the scale was administered to 140 patients with peripheral vestibular system dysfunction and 70 control group (age between 25 and 80 years). After one week, 50 participants were asked to complete the questionnaire again. Eventually, reliability was evaluated with both methods of internal consistency and test-retest reproducibility. Results: Out of the 28 items in the NVI scale, 3 items were modified to better align with the cultural conditions of Iranians. The impact scores for most items in this scale were found to be higher than 1.5. The Cronbach’s alpha coefficient values for the overall scale (0.90) and test-retest reliability with intra-class correlation coefficient for the overall scale (0.91) were confirmed. Conclusion: The Persian version of NVI scale demonstrates excellent validity and reliability, and it exhibits a high level of content alignment with the original version. Therefore, it can be a useful tool to better understand the physical, emotional and cognitive disturbances in patients with vertigo/dizziness. Keywords: Validity; reliability; dizziness; vertigo; vestibular dysfunction; neuropsychological vertigo inventory

Decreased FGF19 and FGF21: possible underlying common pathogenic mechanism of metabolic and cognitive dysregulation in depression.

Accumulating studies suggested that major depressive disorder (MDD) was closely related to metabolic syndrome (MetS). Important endogenous regulators fibroblast growth factors (FGFs) 19 and 21 were also reported to participate in psychiatric disorders. This study aimed to investigate the role of FGF19 and FGF21 in MDD and to explore the possible pathogenic mechanism of metabolic and cognitive dysregulation in depression. A total of 59 MDD patients and 55 healthy control participants were recruited. The serum levels of FGF19 and FGF21 and lipid profiles were measured by means of enzymatic methods. Cognitive function was measured by repeatable battery for the assessment of neuropsychological status (RBANS) scores. The gene expression of PGC-1α and FNDC5 was determined by quantitative polymerase chain reaction (PCR). We found that plasma FGF19 and FGF21 levels were significantly decreased in patients with MDD. Meanwhile, triglyceride (TG) was significantly elevated and PGC-1α was significantly downregulated in MDD patients. Correlation analyses showed negative associations between TG and FGF19 levels. As for cognitive performance, both FGF19 and FGF21 levels were positively correlated with immediate memory. However, FGF19 levels were negatively correlated with language, and FGF21 levels were also negatively correlated with attention and delayed memory. Additionally, negative associations were found between FGF19 levels and PGC-1α. FGF21 levels were positively associated with PGC-1α and negatively associated with FNDC5. This study elucidated the role of FGF19 and FGF21 in MDD. MDD patients were confirmed to have metabolic and cognitive dysregulation, and this abnormality was linked to the decreased concentrations of FGF19 and FGF21 through the PGC-1α/FNDC5 pathway. Our results showed that the alterations of FGF19 and FGF21 levels may be a common pathogenic mechanism of metabolic and cognitive disturbances in patients with MDD.

Impact of COVID‐19 pandemic in an early‐onset dementia clinic in Barcelona

BackgroundThe ongoing COVID‐19 pandemic and related care policies have affected dementia patients. The characteristics of early‐onset dementia (EOD, <65 years) patients in 2020 may provide insights on how to rearrange the provision of care.MethodWe retrospectively reviewed, from 2016 to 2020, the demographic and clinical data of the new referrals at our EOD clinic (Hospital Clínic Barcelona). We used Fisher’s Exact test and Mann–Whitney U test in R4.0.2 (http://www.R‐project.org/) to analyze differences between 2020 and the period 2016‐2019.ResultIn 2020, we did not visit any new referral from 15th march to 31th may. We evaluated 104 patients in 2020 and 392 patients in 2016‐2019 (mean=98(SD=11.8) patients/year). No differences were found in age at onset (AAO), sex, diagnostic delay and MMSE score (Table1). Significant differences were found in the diagnoses obtained in each period (p<0.000005, Figure1A). In 2020, 19.2% of the patients were diagnosed with neurodegenerative diseases (ND), 48.1% with non‐neurodegenerative diseases (NND) and 32.7% with subjective cognitive decline (SCD). On contrast, in 2016‐2019, 26% of the patients were diagnosed with ND, 22.2% with NND and 51.8% with SCD. Compared to 2016‐2019, ND, but not SCD or NND, presented longer diagnostic delay in 2020 (p<0.0005, Figure1B). ND, NND and SCD did not show differences between periods in AAO, sex or MMSE.We did not find differences in the type of ND in each period (Figure1A). Compared to 2016‐2019, Frontotemporal Lobar Degeneration (FTLD) presented longer diagnostic delay in 2020 (p<0.005, Figure1B) while ND subgroups did not show differences in AAO, sex or MMSE. Cognitive disturbances in recovered COVID‐19 patients accounted for 16% of NND in 2020 [N=8, AAO 50.63(12), 63% female, MMSE 26.8(2.3)].ConclusionIn 2020, albeit we were forced to stop our normal activity during 2.5 months, we visited a similar number of patients among which we observed an increase in NND, including cognitive disturbances in patients with recovered COVID‐19. On contrast, we found a reduction in SCD and, to a lesser extent, ND. ND showed a longer diagnostic delay in 2020 that mainly affected FTLD. Whether COVID‐19 pandemic entails a diagnostic delay in dementia patients must be confirmed in 2021.

Prevention and treatment of cognitive disorders in patients with arterial hypertension

The article contains systematized literature data concerning prophylactic and rational approaches of antihypertensive treatment of cognitive disturbances in patients with arterial hypertension (АН). These approaches are based on the results of multi-center, randomized studies in this patient group. It was shown that applying in time antihypertensive drugs having certain cerebroprotecter abilities and correction emotional and metabolic disorders make positive influence on clinics and prognosis of АН, prevent the progressing of cognitive disturbances. It was also shown that in patients with AH associated with cognitive disturbances long-term therapy with angiotensin II antagonists, angiotensin-converting enzymes inhibitors and dihydropyridine calcium blockers make positive influence on clinics and prognosis of АН and could in some cases predict the progress of cerebrovascular disturbances.

Association of transcription factor 4 (TCF4) gene mRNA level with schizophrenia, its psychopathology, intelligence and cognitive impairments

Schizophrenia (SCZ), is considered as one of the most debilitating mental disorders around the world. Symptom-based clinical interview and numerous tests have been used to evaluate the diagnosis and also cognitive disturbances in patients with SCZ. All these tests measure phenotype-based functions. Thus, it seems accurate diagnosis of such complex disorders must rely on more valid and reliable factors. In this study, we evaluated the association of transcription factor 4 (TCF4) gene mRNA level in peripheral blood with SCZ, and also its psychopathology, cognitive and intellectual impairments. In this study, using real-time PCR, we compared TCF4 mRNA level between the case (70 unmedicated schizophrenia patients) and healthy control (n = 72) groups. In addition, all subjects underwent Psychopathology (PANSS) and cognitive and intelligence (WAIS, WMS, Stroop, WCST) assessments, and scores were compared between the two groups. Also, to determine the effect of TCF4 expression on psychopathology, cognitive and intellectual functions, the correlation between expression level and test scores was measured. The correlation between gene expression and age of onset and duration of the disorder was evaluated as well. Our results showed that the TCF4 mRNA level, psychopathology, cognitive and intellectual functions were significantly different in all, male, and female patients compared to healthy participants. Additionally, it was found that TCF4 level is positively correlated with scores of WAIS and WMS and is negatively correlated with Stroop and WCST errors and PANSS score. Our results showed that the mRNA level of TCF4 may be associated with SCZ, its psychopathology, IQ and cognitive impairments in an Iranian group of patients with SCZ. These results may help to better understanding the TCF4 role in the psychopathogenesis of SCZ and also may shed some light on the ongoing works conducted on peripheral biomarker-based diagnosis of complicated mental disorders.

FROM THE BLOOD- BRAIN BARRIER TO BEHAVIOR

Research in the field of neuropsychoimmunology has enabled the researchers to show that cytokines target the brain to organize a "sickness response," which is fever, activation of hypothalamuspituitary- adrenal axis and behavioural alterations that develop in sick individuals. perypheral cytokines do not act directly on the brain; they trigger the production of cytokines in the brain parenchima itself, with a possible relay at the interface between internal milieeu and the brain, which are endothelial cells and circumven- tricular organs. The affective and behavioural changes that develop during in- fluenza are the product of a transient brain inflammatory response induced by the same proinflammatory cytokines that are produced in the bronchial tree. the cytokine pattern is distal to this phenomenon while the receptor molecules that decipher the molecular nature of microbial pathogens (pathogens associated molecular patterns PAMPs) at the membrane level of cells is a proximal factor. PAMPs are recognized by specialized receptors on innate immune cells that belong to the TOLL/IL-1 like recep-tor family. these receptors are phylogenetically old. the brain uses these receptors to defend itself against something different (several forms of brain injury that have nothing to do with infec- tious pathogens) from infectious pathogens. Assuming that the factors that activate these receptors involve endogenous substances derived by cell death (cell death by-products) is the concept at the origin of the danger theory. Evidence in favor of a citokines role in mediating mood disorders and cognitive disturbances in patients receiving cytokine immunotherapy is fast growing. (capuron e dantzer 2003) Several items of data support the role for cytokines in mediating a variety of non - specific symptoms that develop in patients suffering from disea- ses with an inflammatory component (cad, immunorheumatolic, neuropathologies (Cleeland 2003, Eikelenboom 2002, Gidron 2002, Kiecolt-Glaser and glaser 2002). These non-specific neurovegetative and psychiatric symptoms represent just another facet of the ingflammatory process and they are not necessarily derived from a direct cause-effect chain.

Cognitive dysfunctions and psychological symptoms in migraine without aura: a cross-sectional study.

BackgroundThe occurrence of cognitive dysfunctions and psychological symptoms, as well as their mutual relationships, in migraine patients are still debated. The aim of the study was to characterize the cognitive profile and psychological symptoms (i.e. depression, anxiety and apathy) in drug-naïve migraine without aura (MwoA) patients.MethodsSeventy-two consecutive MwoA patients, referred to the Italian University Headache Clinic and 72 healthy subjects (HCs) were enrolled. Patients, during an attack-free period, and HCs completed Montreal Cognitive Assessment (MoCA), Beck Depression Inventory-II (BDI-II), Self-version of Apathy Evaluation Scale (AES-S) and State and Trait Anxiety Inventory (STAI-Y-1 and 2). Clinical parameters of disease severity (i.e. disease duration, migraine attacks per month, mean pain intensity during migraine attacks, migraine disability and impact on daily life) were recorded.ResultsAlthough performance of MwoA patients on MoCA was above Italian cut-off threshold (<15.5) suggesting presence of cognitive impairment, MwoA patients achieved significantly lower scores than HCs on total MoCA scale (22.3 ± 2.7 versus 25.4 ± 2.3) and on its attention (4.9 ± 1.1 versus 5.6 ± 0.7), memory (1.8 ± 1.4 versus 3.1 ± 1.3), visuospatial (3.2 ± 0.9 versus 3.6 ± 0.6) and executive subscales (2.6 ± 1.1 versus 3.1 ± 0.8). In addition, we observed significant correlations between MoCA executive domain subscore and the attack-related disability score (MIDAS).As for behavioral profile, the percentage of depressive symptoms (4.2 %), high state and trait anxiety (13.9 and 9.7 %, respectively), and apathy (11.1 %) in MwoA patients were similar to that of HCs. No significant associations of behavioural symptoms with cognitive performance and clinical parameters were found.ConclusionsDrug-naïve MwoA patients are characterized by subtle cognitive dysfunctions and low percentage of behavioural symptoms. The results support the importance of searching for subclinical cognitive disturbances in patients with MwoA, who deserve to be followed-up to verify whether they develop clinically relevant disorders over time.

PREVENTION AND TREATMENT OF COGNITIVE DISORDERS IN PATIENTS WITH ARTERIAL HYPERTENSION

The article contains systematized literature data concerning prophylactic and rational approaches of antihypertensive treatment of cognitive disturbances in patients with arterial hypertension (АН). These approaches are based on the results of multi-center, randomized studies in this patient group. It was shown that applying in time antihypertensive drugs having certain cerebroprotecter abilities and correction emotional and metabolic disorders make positive influence on clinics and prognosis of АН, prevent the progressing of cognitive disturbances. It was also shown that in patients with AH associated with cognitive disturbances long-term therapy with angiotensin II antagonists, angiotensin-converting enzymes inhibitors and dihydropyridine calcium blockers make positive influence on clinics and prognosis of АН and could in some cases predict the progress of cerebrovascular disturbances.

Tryptophan hydroxylase 2 gene is associated with cognition in late-onset depression in a Chinese Han population

Accumulating evidences suggest that Tryptophan hydroxylase 2 (TPH2) gene is associated with major depressive disorder (MDD) and cognitive function. In present study, we aimed to explore the association of cognitive disturbances in patients with late-onset depression (LOD) in the Chinese Han population. One hundred and ninety unrelated LOD patients who met DSM-IV criteria for major depressive disorder were recruited for the study and 155 normal controls were recruited from local community. All subjects completed the demographic assessments. Furthermore, 97 patients and 44 controls completed a series of neuropsychological tests. Patients and normal controls were genotyped for TPH2 (rs4290270 and rs7305115) variants using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The results of our analysis indicated no significant differences in the frequencies of the single alleles and genotypes of two polymorphisms in TPH2 gene between LOD patients and normal controls. Haplotype association indicated that no differences were found in the frequencies of haplotype between two groups. A significant main effect of rs4290270 genotype on Verbal Fluency Test (VFT) test performance was found (P<0.05). There was a significant interactive effect of rs7305115 polymorphisms and depression diagnosis on Symbol Digit Modalities Test (SDMT) (P<0.05). After controlling for covariates, the subjects with carriers of GG genotype in rs7305115 had more better SDMT performance compared to AG and AA carriers in LOD groups. The result suggests that there is a major effect of rs4290270 in TPH2 on cognitive function alone. Moreover, an interaction of rs7305115 polymorphisms and depression diagnosis may be associated with the cognitive function. Further studies in a large sample are needed to replicate the genetic role in the LOD patients.

EPA-1734 – Clinical features, personality and cognitive disturbances in patients with “medically unexplained” symptoms

Objectives Somatoform-type disorders or’medically unexplained’ symptoms (MUS) represent variable group of psychopathological syndromes. It is considered that sensory, emotional, cognitive and personality mechanisms play role in the genesis of MUS. The aim of the study was to analyze the relationship among personality types, clinical manifestations, and cognitive disturbances that occur in patients with MUS. Material and Methods 106 patients with different MUS were studied with the help of clinical and psychological tests - Minnesota Multiphase Personality Inventory (MMPI), 16 Personality Factors Questionnaire, Temperament and Character Inventory, Giessen Subjective Complaints List, Patient Health Questionnaire 15-Item Somatic Symptom Severity Scale, Toronto Alexithymia Scale, Somatosensory Amplification Scale, Addenbrooke's Gognitive Examination, Frontal Assessment Battery, Dissociation Scale. Results Five types of behavior patterns of patients with MUS were revealed with the help of MMPI profile analysis – schizotypical hypochondria (SH), hysterical hypochondria (HYH),’organic’ hypochondria (OH), depressive hypochondria (DH) and pshychovegetative subdepressive hypochondria (PVH). Patients with HYH, DH, PVH were characterized by alexithymia, high dissociation and amplification. Patients with OH had disturbances of memory and spatial gnosis. SH had high hypochondriac concerns (irrational health believes), subdepressive affect, disturbances of process of conceptualization. Conclusion MUS have complex psychopathological structure, which includes not only quantity of somatic complaints, intensity of hypochondriac concerns, evidence of anxiety and depressive symptoms. Important components of MUS are represented by cognitive style disturbances (alexithymia, dissociation, sensory amplification) and neurocognitive deficit (insufficient spatial gnosis, constructive and conceptualization abilities, memory, dynamic praxis). Different personality and behavior styles evidently integrate this continuum of disturbances in several superordinate somatoform-type syndromes.

Minor cognitive disturbances in X-linked spinal and bulbar muscular atrophy, Kennedy's disease

Spinal and bulbar muscular atrophy (SBMA), Kennedy's disease, is an adult-onset hereditary neurodegenerative disorder, associated predominantly with a lower motor neuron syndrome and eventually endocrine and sensory disturbances. In contrast to other motor neuron diseases such as amyotrophic lateral sclerosis (ALS), the impairment of cognition in SBMA is not well documented. We conducted a systematic cross-sectional neuropsychological study in order to investigate cognition in SBMA patients more thoroughly. We investigated 20 genetically proven SBMA patients compared to 20 age- and education-matched control subjects using a comprehensive neuropsychological test battery, measuring executive functioning, attention, memory and visuospatial abilities. The SBMA patients performed significantly worse than healthy controls in three sub-tests in the executive and attention domains. This low performance was in the working memory (digit span backward task), verbal fluency category (single letter fluency task) and memory storage capacity (digit span forward task). No disturbances were detected in other cognitive domains. The impairments were subclinical and not relevant to the patients’ everyday functioning. In addition, no correlations were found between cognitive scores and the CAG repeat length. In conclusion, we found minor cognitive disturbances in patients with SBMA, which could indicate subtle frontal lobe dysfunction. These findings extend our neurobiological understanding of SBMA.

565 – Abnormality of white matter structure and resting state brain function in first-episode, treatment-naive patients with major depressive disorder

Introduction Increasing evidence indicates that major depressive disorder (MDD) is associated with cognitive as well as mood disturbances. Objectives To evaluate cognitive function and white matter structure, resting-state brain function in first-episode, treatmentnaive patients with MDD. Aims To explore brain structure and function mechanisms of cognitive impairment in MDD. Methods 46 Han Chinese MDD patients aged 18–45 year and 46 controls were assessed by a series of validated test procedures.Then, 30 patients and 30 controls were obtained by MRI scan.White matter abnormalities evaluated using diffusion tensor imaging (DTI) were analyzed using tract based spatial statistics (TBSS) and resting-state brain function was evaluated using regional homogeneity (ReHo) analysis. Results Cognitive impairment in patients with MDD was demonstrated by reduced accuracy in the Wisconsin Card Sorting test (WSCT) and to a lesser extent the Continuous Performance test (CPT) and Trail Making tests (TMT). White matter abnormalities found in the left cerebellum, and resting-state abnormalities present in the left inferior parietal gyrus, left anterior cingulate nucleus and left hippocampal gyrus were associated with impaired performance in the WSCT and CPT tests. We also showed that poor WSCT performance was associated with increased interconnectivity between the left ventral anterior cingulate nucleus and the medial frontal lobe areas. Conclusions The present study indicates cognitive disturbances in patients with MDD are associated with white matter and resting-state changes and altered interconnections in specific brain areas.

Cognitive Improvement by Activation of &amp;#945;7 Nicotinic Acetylcholine Receptors: From Animal Models to Human Pathophysiology

Agonists and positive allosteric modulators of the alpha(7) nicotinic acetylcholine receptor (nAChR) are currently being developed for the treatment of cognitive disturbances in patients with schizophrenia or Alzheimer's disease. This review describes the neurobiological properties of the alpha nAChR and the cognitive effects of alpha(7) nAChR activation, focusing on the translational aspects in the development of these drugs. The functional properties and anatomical localization of the alpha(7) nAChR makes it well suited to modulate cognitive function. Accordingly, systemic administration of alpha(7) nAChR agonists improves learning, memory, and attentional function in variety of animal models, and pro-cognitive effects of alpha(7) nAChR agonists have recently been demonstrated in patients with schizophrenia or Alzheimer's disease. The alpha(7) nAChR desensitizes rapidly in vitro, and this has been a major concern in the development of alpha(7) nAChR agonists as putative drugs. Our review of the existing literature shows that development of tolerance to the behavioral effects of alpha(7) nAChR agonists does not occur in animal models or humans. However, the long-term memory-enhancing effects seen in animal models are not mimicked in healthy humans and schizophrenic patients, where attentional improvement predominates. This discrepancy may result from inherent differences in testing methods or from species differences in the level of expression of alpha(7) nAChRs in limbic brain regions, and may hamper preclinical evaluation of alpha(7) nAChR activation. It is therefore important to consider the translational power of the animal models used before entering into a clinical evaluation of the pro-cognitive effects of alpha(7) nAChR activation.

Cognitive disturbances in patients with multiple sclerosis

Multiple sclerosis (MS) one of the most common neurological diseases. MS — autoimmune disease of CNS, characterized by myelin destruction and axonal damage. The aim of the study was to analyse the role of cognitive disorders in MS. Neurocognitive functions have been studied in 109 patients with MS. To study cognitive functions, the authors used the Mini-Mental State Examination (MMSE), the frontal assessment battery, the procedure developed by A.R. Luriya. It is emphasized that cognitive disturbance may appear on the earlier stages of MS.

Avaliação dos potenciais evocados relacionados a eventos (ERP-P300) em pacientes com cirrose hepática sem encefalopatia

In hepatic cirrhosis structural liver alterations occur leading to the loss of the organ functions with neuro-psychiatric consequence, as cognitive dysfunctions. One of the most effective ways of objectively evaluating cognition is to measure electrophysiological activity in the central nervous system trough event-related potentials (ERP-P300). To assess the value of the event-related potential (ERP) in order to determine cognitive disturbances in patients with liver cirrhosis and to assist in the diagnosis of minimal hepatic encephalopathy. Fifty patients with liver cirrhosis were selected, without clinical symptoms of hepatic encephalopathy and 35 healthy volunteers, matched by sex and age. The patients were submitted to clinical-neurological and laboratorial examination. The ERP-P300 was performed by the two groups to determine cognitive disturbances. The study showed significant differences between the ERP-P300 latency averages of the two groups. The ERP-P300 is simple to use and depends on controllable variables. It is also easy to reproduce and, when properly used, can be useful both to determine cognitive disturbances in patients with hepatic cirrhosis and to assist in minimal hepatic encephalopathy diagnosis.

Cognitive dysfunction and diabetes: Implications for primary care

It is increasingly recognized that diabetes mellitus can lead to long-term complications in the brain. Clinically, these complications are manifested in alterations in cognitive functioning. This paper offers an overview on the impact of diabetes on cognition and provides leads for the evaluation and management of cognitive disturbances in patients with diabetes in a primary care setting. The main message is that while some patient groups appear to be at increased risk of cognitive impairments, in the majority of patients diabetes is not associated with the development cognitive decrements that would be regarded as clinically relevant. Frank impairments of cognition mainly occur in patients above the age of 65, often in association with vascular co-morbidity. Other groups at risk for cognitive decrements are children with an early age at diabetes onset and patients with clinically manifest retinopathy or other microvascular complications. No specific treatment options are available, but for now treatment of vascular risk factors and attention for glycaemic control appears to be a logical approach. Given the recent progress in this field, new treatments to prevent cognitive impairment in patients with diabetes may hopefully become available in the near future.

Case-referent comparison of cognitive functions in patients receiving haematopoietic stem-cell transplantation for haematological malignancies: Two-year follow-up results

During bone marrow or haematopoietic stem-cell transplantation (HSCT), potentially neurotoxic treatments are used. Previous studies identified cognitive disturbances in patients treated with HSCT, but prospective studies with longitudinal assessment are sparse. We examined cognitive functions up to 20 months after a first baseline assessment in 101 patients undergoing HSCT and in 82 reference patients with a haematological malignancy treated with non-myeloablative cancer therapies. Baseline findings revealed no between-group differences and demonstrated mild cognitive impairments in both groups. Follow-up analyses showed no significant changes over time, though poorer performance in attention and executive function, and psychomotor function was found in HSCT patients. Our results suggest limited HSCT-related cognitive dysfunctions. Additional follow-up is necessary to assess long-term effects.

P4-222: Dementia behavioral and cognitive disturbances and the concept of hope in caregivers

Dementia is a main source of caregiver burden and distress. Several psychosocial approaches has been proposed as able to relieve distress in caregivers. Most of the psychosocial intervention includes psychoeducation and /or supportive approaches in order to lead caregivers to appropiate coping with the impact of the disease on cognitive, functional, behavioral and personality changes. The latter may lead caregivers to assume the characteristics of acute distress. There are several studies underlying the impact of dementia in caregiver. This may lead to psychological burden and to depressive symptoms. A hypothesis to be tested is that behavioral and cognitive disturbances in patients with dementia may lead to acute distress through the loss of hope. The sample comprised caregivers of patients with dementia. A total of 53 caregivers (44 female and 9 male) enrolled in the study based in Eginition Hospital, Department of Psychiatry, with age range 27–81 years. Caregivers were tested with the State Hope Scale, Emotional Distress Scale, Beck Depression Inventory and the Neuropsychiatry Inventory and Mini Mental State Examination were used for patients with dementia. There was statistically significant difference on BDI scores for caregivers living with the patient compared with caregivers that are not living with the patient (F=4.513, p=0.039). BDI scores are statistically significant with NPI total score 0.352, p=0.014 and Hope scale total score was related with MMSE. Our results suggest that loss of hope as a cognitive construct is related with depression and severe psychological burden. Furthermore, there was any impact on hope from the Neuropsychiatric symptoms when the later could be responsible for depressive symptomatology in this group of caregivers.

Cognitive dysfunction in epilepsy: Case reports

Cognitive dysfunction in people with epilepsy is a frequently encountered but also easily overlooked problem. In this article three patients with epilepsy are presented with cognitive problems due to a relapse of seizures, due to continuing absence seizures or as a consequence of deteriorating mental functions resulting from frequent complex partial seizures. In the last patient the decline in mental functioning was also demonstrated in a disseminated activation pattern on her fMRI, which contrasts with the localised activity as seen in controls on fMRI. Suggestions how to handle these problems in daily practice are given.

The loss of neuronal integrity may be one of the causes of cognitive disturbances in the patients with brain traumatic injury and normal FLAIR and T2-weighted MRI

Objective: Traumatic brain injury causes cognitive disturbances in many cases. Some patients have moderate–severe brain dysfunction despite slight or no abnormality in MRI. The purpose of this study is to investigate whether the loss of neuronal integrity exists in the patients with traumatic brain injury using C-11 flumazenil PET (FMZ-PET) without MRI abnormality. Method: This study included 11 patients with traumatic brain injury and posttraumatic cognitive disturbances. All of the studies were examined at least 6 months later after injury. The dynamic flumazenil PET was studied in all patients. The binding potential of flumazenil (BP) was calculated by reference method. Axial T1WI, T2WI and FLAIR images were obtained with 1.5-T scanner. Coronal images were added in some cases. The BP images were visually interpreted by at least two experienced nuclear physicians by consensus. The lesions were determined as positive if a definite localized area of decreased distribution with respect to the surrounding normal tissue was present except for physiological distribution. Results: All of the patients had normal T1, T2 and FLAIR MRI. Nine patients had memory impairment. The low uptakes of BP images were shown in seven patients (63%). The low uptakes of BP were shown in the medial temporal lobe, the lateral temporal lobe, the temporal base and the frontal lobe in five, one, one and two patients, respectively. There were no patients that had low uptake in the cerebellum. Six of the nine patients who had memory impairment showed low uptakes in BP in the temporal lobe. Conclusion: These results indicated that the loss of the neuronal integrity, which was not able to be detected with MRI, was one of the causes of the cognitive disturbances in patients with traumatic brain injury.