Cognitive Dysfunction Score Research Articles

Lithium Aspartate for Long COVID Fatigue and Cognitive Dysfunction

Neurologic post-COVID-19 condition (PCC), or long COVID, symptoms of fatigue and cognitive dysfunction continue to affect millions of people who have been infected with SARS-CoV-2. There currently are no effective evidence-based therapies available for treating neurologic PCC. To assess the effects of lithium aspartate therapy on PCC fatigue and cognitive dysfunction. A randomized, double-blind, placebo-controlled trial (RCT) enrolling participants in a neurology clinic from November 28, 2022, to June 29, 2023, with 3 weeks of follow-up, was conducted. Subsequently, an open-label lithium dose-finding study with 6 weeks of follow-up was performed among the same participants enrolled in the RCT. Eligible individuals needed to report new, bothersome fatigue or cognitive dysfunction persisting for more than 4 weeks after a self-reported positive test for COVID-19, Fatigue Severity Scale-7 (FSS-7) or Brain Fog Severity Scale (BFSS) score of 28 or greater, Beck Depression Inventory-II score less than 24, and no history of a condition known to cause fatigue or cognitive dysfunction. All participants in the RCT were eligible for the dose-finding study, except for those who responded to the placebo. Intention-to-treat analysis was used. Lithium aspartate, 10 to 15 mg/d, or identically appearing placebo for 3 weeks followed by open-label lithium aspartate, 10 to 15 mg/d, for 2 weeks. In the subsequent dose-finding study, open-label lithium aspartate dosages up to 45 mg/d for 6 weeks were given. Change in sum of FSS-7 and BFSS scores. The scores for each measure range from 7 to 49, with higher scores indicating more severe symptoms. Secondary outcomes included changes from baseline in the scores of additional questionnaires. Fifty-two participants were enrolled (30 [58%] males; mean [SD] age, 58.54 [14.34] years) and 26 were randomized to treatment with lithium aspartate (10 females) and 26 to placebo (12 female). Two participants assigned to lithium aspartate were lost to follow-up and none withdrew. No adverse events were attributable to lithium therapy. There were no significant intergroup differences for the primary outcome (-3.6; 95% CI, -16.6 to 9.5; P = .59) or any secondary outcomes. Among 3 patients completing a subsequent dose-finding study, open-label lithium aspartate, 40 to 45 mg/d, was associated with numerically greater reductions in fatigue and cognitive dysfunction scores than 15 mg/d, particularly in 2 patients with serum lithium levels of 0.18 and 0.49 mEq/L compared with 1 patient with a level of 0.10 mEq/L. In this RCT, therapy with lithium aspartate, 10 to 15 mg/d, was ineffective for neurologic PCC fatigue and cognitive dysfunction. Another RCT is required to assess the potential benefits of higher lithium dosages for treating neurologic PCC. ClinicalTrials.gov Identifier: NCT05618587 and NCT06108297.

Hippocampal transcriptome analysis reveals mechanisms of cognitive impairment in beagle dogs with type 1 diabetes.

Diabetic encephalopathy is a common complication of type 1 diabetes. However, there have been few studies on cognitive impairment and hippocampal damage in type 1 diabetes mellitus (T1DM) using dogs as experimental animals. To investigate the effects of diabetes on the CNS, 40 adult beagles were divided into streptozotocin/alloxan type 1 diabetes model and control groups. The duration of diabetes in the model group was 120 days. A cognitive dysfunction scale was used to assess cognitive function. Hematoxylin and eosin and Golgi-Cox staining methods were used to observe morphological damage to the hippocampus. Transcriptomics was used to investigate differential gene expression in the hippocampus. The results showed that the cognitive dysfunction score of the model group was significantly higher than that of the control group. In addition, the number of normal neurons, the complexity of dendritic morphology, and the density of dendritic spines were decreased in the hippocampus of diabetic dogs. A total of 672 differentially expressed genes (DEGs) were identified, 289 of which were upregulated, and 383 were downregulated. Modified genes included DBH, IGFBP2, AVPR1A, and DRAXIN. In conclusion, type 1 diabetic dogs exhibit cognitive dysfunction. The DEGs were mainly enriched in metabolic, PI3K-Akt signaling, and neuroactive ligand-receptor interaction pathways.

Dietary Supplemented Anthocyanin Reduced Serum Amyloid Beta Oligomers and Improved Cognitive Dysfunction Scores in Elderly Dogs

Like humans, the accumulation of amyloid-beta oligomers in the brains of aged dogs leads to cognitive dysfunction. Our study investigated the effects of dietary flavonoids in pet foods on cognitive dysfunction. All nine dogs (six species) recruited were older than seven years, and cognitive function was measured using a questionnaire before and after applying pet food containing cyanidin-3-O-glucoside, the main component of honeyberries. Physical examination, blood tests, cognitive dysfunction scores, and serum amyloid-beta oligomers were measured. After 90 days of pet food administration, a physical examination revealed no abnormalities in weight, body temperature, heart rate, or respiratory rate. However, the cognitive dysfunction score and serum amyloid-beta oligomers (AβO) marker levels were significantly reduced after 90 days. Inflammation and antioxidant levels were slightly, but not significantly, changed. Our results suggest that pet food containing anthocyanins effectively improves cognitive dysfunction scores and decreases serum AβO levels.

Deep learning signature of brain [18F]FDG PET associated with cognitive outcome of rapid eye movement sleep behavior disorder

An objective biomarker to predict the outcome of isolated rapid eye movement sleep behavior disorder (iRBD) is crucial for the management. This study aimed to investigate cognitive signature of brain [18F]FDG PET based on deep learning (DL) for evaluating patients with iRBD. Fifty iRBD patients, 19 with mild cognitive impairment (MCI) (RBD-MCI) and 31 without MCI (RBD-nonMCI), were prospectively enrolled. A DL model for the cognitive signature was trained by using Alzheimer’s Disease Neuroimaging Initiative database and transferred to baseline [18F]FDG PET from the iRBD cohort. The results showed that the DL-based cognitive dysfunction score was significantly higher in RBD-MCI than in RBD-nonMCI. The AUC of ROC curve for differentiating RBD-MCI from RBD-nonMCI was 0.70 (95% CI 0.56–0.82). The baseline DL-based cognitive dysfunction score was significantly higher in iRBD patients who showed a decrease in CERAD scores during 2 years than in those who did not. Brain metabolic features related to cognitive dysfunction-related regions of individual iRBD patients mainly included posterior cortical regions. This work demonstrates that the cognitive signature based on DL could be used to objectively evaluate cognitive function in iRBD. We suggest that this approach could be extended to an objective biomarker predicting cognitive decline and neurodegeneration in iRBD.

Convergent and divergent cognitive impairment of unipolar and bipolar depression: A magnetoencephalography resting-state study

BackgroundUnipolar depression (UD) and bipolar depression (BD) showed convergent and divergent cognitive impairments. Neural oscillations are linked to the foundational cognitive processes. We aimed to investigate the underpinning spectral neuronal power patterns by magnetoencephalography (MEG), which combinates high spatial and temporal resolution. We hypothesized that patients with UD and BD exhibit common and distinct patterns, which may contribute to their cognitive impairments. MethodsGroup cognitive tests were performed. Eyes closed resting-state MEG data were collected from 61 UD, 55 BD, and 52 healthy controls (HC). Nonparametric cluster-based permutation tests were performed to deal with the multiple comparison problem on channel-frequency MEG data. Correlation analysis of cognitive dysfunction scores and MEG oscillation were conducted by Spearman or partial correlation analysis. ResultsWisconsin Card Sorting Test showed similar cognitive impairment in patients with UD and BD. Moreover, patients with BD exhibited extensive cognitive deficits in verbal executive functions and visuospatial processing. Compare to HC, both patients with UD and BD showed increased frontal-central beta power while high gamma power was decreased in UD groups during the resting-state. The significant correlations between cognitive function and average beta power were observed. ConclusionsPatients with BD had more cognitive impairments on different dimensions than those with UD, involving disrupted beta power modulations. Our investigation provides a better understanding of the neuroelectrophysiological process underlying cognitive impairments in patients with UD and BD.

Depression, cognitive dysfunction and other factors associated with 5-year overall mortality in type 2 diabetes mellitus: a pilot prospective observational study

BACKGROUND: Psychological predictors of overall mortality in the Russian population of Type 2 diabetic patients and their impact compared to biological risk factors have not been studied.AIM. To identify clinical, laboratory and psychological factors independently associated with the 5-year overall mortality in Type 2 diabetic patients in the Moscow region.MATERIALS AND METHODS: This open label observational prospective study included 178 consecutive type 2 diabetic patients (women 145, men 33, age range 37 to 82 years, duration of diabetes 0,5 to 30 years). At baseline, in addition to the standard clinical, laboratory and instrumental work-up, all patients were assessed for depression, cognitive dysfunction and diabetes-related quality of life. No study-related intervention was performed; all patients were followed up and treated by their local physicians. After 5 years, we assessed the patients’ vital status (alive or dead). Multiple logistic regression was used to identify baseline patients’ characteristics, which were significantly and independently associated with 5-year overall mortality. Taking into account the exploratory type of multiple regression, the results were considered significant at α<0.1.RESULTS: At 5 years, 150 (84%) patients were alive and 15 (8,4%) were dead; no information could be obtained for the rest 13 (7,3%) patients. The analysis of 165 patients with the verified outcome, independent and significant associations with the death outcome were found for male gender (odds ratio [OR] 6,36 [95%CI 0,91–44.40]; p=0.06), age (OR 2.06 [1.30–3.27]; p<0.002), chronic heart failure (CHF) (OR 2.78 [1.25–6.2]; р=0.012), Hamilton depression scale score (OR 1,18 [1.03–1.34]; р=0.016), cognitive dysfunction score (Roschina scale) (OR 1.20 [1.05–1.35]; р=0.006), and age — body mass index interaction (OR 0,98 [0,97–0,997]; р = 0,013). The predicted probability of death within the next 5 years in men and women was 22,9% and 6,7%, respectively. The highest score of cognitive dysfunction was associated with a 25% predicted probability of death and the lowest, with a 2% probability of death; predicted probabilities of death for the highest and lowest depression scores were 26% and 2%, respectively. The 5-year predicted probability of death in the patients without CHF was 6,7%, with CHF I NYHA functional class, 9,8%, II functional class 13,6%, III functional class 18,2%, and IV functional class 23,5%. All other baseline clinical, laboratory, demographic, psychological and socioeconomic variables were not significantly associated with the 5-year survival rate. The model was not verified on an external cohort.CONCLUSION: Cognitive dysfunction and depression have a significant negative impact on the 5-year mortality rate at much higher degree, than glycemic control, any diabetes-related complications and cardiovascular disorders, excluding CHF. The results obtained highlight the importance of the diagnosis and treatment of depression and cognitive dysfunction in type 2 diabetes mellitus.

Correlates of Severity of Depression in Different Geographical Regions of

Objective: To access the Severity of Depression and cognitive impairment in different Geographical Regions of Pakistan Methodology: A prospective observational study was undertaken as a subsidiary of a multicentered study conducted between April to October 2018 at 2019 in psychiatric clinics all over Pakistan. Patients presented to the outpatients departments at study sites across PAKISTAN were assessed for depression severity using Patient Health Questionnaire-9 (PHQ-9). Each patient was assessed for cognitive impairment as well. The perceived deficits questionnaire (PDQ) was used to assess the degree of impairment. A total of 820 patients were a part of this study. Results: The highest frequency of mild depression was seen in Punjab (0.90%) whereas the highest frequency of moderate depression was seen in KPK(47.20%), Moderately Severe depression in Azad Kashmir (65.70%) and Severe depression in Punjab (40.90%) respectively. The mean perceived cognitive dysfunction scores in Punjab, Sindh, Balochistan, KPK, Azad Kashmir were 52.63 ± 12.77, 48.45 ± 12.482, 51.85 ± 9.207, 49.92 ± 16.848, and 45.16 ± 14.615 respectively. Conclusion: Punjab had a significantly higher incidence of severe depression as compared to other provinces. Lowest incidence of severe depression was found in the Azad Kashmir population Keywords: depression, Pakistan, cognitive dysfunction, Patient Health Questionnaire-9 (PHQ-9).

Cognitive dysfunction severity evaluation in dogs with naturally-occurring Cushing´s syndrome: A matched case-control study

Hypercortisolism has been associated with impairment of cognitive function in humans with Cushing's syndrome (CS), but there are currently no studies looking into this effect in dogs with CS. The present study evaluated the pattern of cognitive deficits and behavioral changes in dogs with naturally-occurring CS (NOCS). A previously published questionnaire (DISHA - disorientation, changes in interactive behavior, sleep-wake cycle disturbances, house-soiling, and changes in activity) was used to assess cognitive dysfunction (CD) in dogs with recently diagnosed CS, and in age-, sex-, and gonadal status-matched dogs (1:2), according to their owners’ perception. The questionnaire consisted of 32 multiple-choice questions, scored 0 to 96. The higher the score, the higher the severity of CD. The questionnaire included eight categories of behavioral signs, namely: disorientation, social interactions, sleep-wake cycles, house-soiling, compulsive behaviors, depressive behaviors, anxiety, and memory and learning. Of the 57 dogs assessed in the study, 19 were included in the CS group and 38 in the control group. Exclusion criteria for the control group were animals suspected of having CS, chronic glucocorticoid therapy, or glucocorticoid exposure in the past month. Dogs with CS exhibited a higher final score (Wilcoxon test) of cognitive dysfunction (W = 149, P = 0.001), especially, higher memory dysfunction (W = 96, P = 0.01), compulsive behaviors (W = 93, P = 0.04), depressive behaviors (W = 86, P = 0.03), and anxiety (W = 117, P = 0.001). There was no correlation between age and CD score in dogs with NOCS (r = 0.32, P = 0.465) and neither control dogs (r = 0.18, P = 0.051). Results suggest hypercortisolism may accelerate neurodegenerative process, thus resulting in more intense behavioral and cognitive changes than those observed in age-matched dogs without CS.

Prevalence and Predictors of Prolonged Cognitive and Psychological Symptoms Following COVID-19 in the United States.

Background/ObjectivesLittle is known regarding the prevalence and predictors of prolonged cognitive and psychological symptoms of COVID-19 among community-dwellers. We aimed to quantitatively measure self-reported metrics of fatigue, cognitive dysfunction, anxiety, depression, and sleep and identify factors associated with these metrics among United States residents with or without COVID-19.MethodsWe solicited 1000 adult United States residents for an online survey conducted February 3–5, 2021 utilizing a commercial crowdsourcing community research platform. The platform curates eligible participants to approximate United States demographics by age, sex, and race proportions. COVID-19 was diagnosed by laboratory testing and/or by exposure to a known positive contact with subsequent typical symptoms. Prolonged COVID-19 was self-reported and coded for those with symptoms ≥ 1 month following initial diagnosis. The primary outcomes were NIH PROMIS/Neuro-QoL short-form T-scores for fatigue, cognitive dysfunction, anxiety, depression, and sleep compared among those with prolonged COVID-19 symptoms, COVID-19 without prolonged symptoms and COVID-19 negative subjects. Multivariable backwards step-wise logistic regression models were constructed to predict abnormal Neuro-QoL metrics.ResultsAmong 999 respondents, the average age was 45 years (range 18–84), 49% were male, 76 (7.6%) had a history of COVID-19 and 19/76 (25%) COVID-19 positive participants reported prolonged symptoms lasting a median of 4 months (range 1–13). Prolonged COVID-19 participants were more often younger, female, Hispanic, and had a history of depression/mood/thought disorder (all P < 0.05). They experienced significantly higher rates of unemployment and financial insecurity, and their symptoms created greater interference with work and household activities compared to other COVID-19 status groups (all P < 0.05). After adjusting for demographics, past medical history and stressor covariates in multivariable logistic regression analysis, COVID-19 status was independently predictive of worse Neuro-QoL cognitive dysfunction scores (adjusted OR 11.52, 95% CI 1.01–2.28, P = 0.047), but there were no significant differences in quantitative measures of anxiety, depression, fatigue, or sleep.ConclusionProlonged symptoms occurred in 25% of COVID-19 positive participants, and NeuroQoL cognitive dysfunction scores were significantly worse among COVID-19 positive subjects, even after accounting for demographic and stressor covariates. Fatigue, anxiety, depression, and sleep scores did not differ between COVID-19 positive and negative respondents.

Human APRIL and FGF-21 and adhesion molecules in relation to cognitive function in elderly diabetic patients

A diverse combination of etiologies such as vascular and inflammatory factors and social and physical inactivity may take place in the etiology of cognitive dysfunction (CD). Diabetes mellitus (DM) may contribute to CD over insulin resistance, inflammation, and vascular risk factors. However, mechanisms included in the process are not very clear. We aimed to investigate serum levels of selected biomarkers as a proliferation-inducing ligand (APRIL), FGF-21, P-selectin, soluble vascular cell, and intercellular adhesion molecules-1 (sVCAM-1 and sICAM-1) in elderly patients with DM in relation to cognitive function. A group of 80 elderly type 2 diabetic patients from the outpatient clinic, consisting of 40 patients with CD (mini-mental state examination (MMSE) score < 24) and 40 individuals without CD were enrolled in the study. Anthropometric, sociodemographic, and functional-glycemic evaluations were determined. Biomarker levels were determined by enzyme-linked immunosorbent assay. Median sICAM-1 and FGF-21 levels were higher, and P-selectin level, activities of daily living (ADL), instrumental ADL, MNA, and MMSE scores were lower in the CD group (p = 0.002, p = 0.010, p = 0.001, p = 0.001, p < 0.001, p = 0.005, p < 0.001, respectively). There was no significant difference between the groups regarding age, gender, living status, education, cigarette and alcohol consumption, antidiabetic therapy as well as comorbidities such as hypertension and other diseases, depression, body composition, sVCAM-1, APRIL levels, and related biochemical values. Median sICAM-1 and FGF-21 levels were higher and P-selectin level was lower in older diabetic patients with CD than in patients with normal cognitive status. Understanding the mechanisms may lead to the prevention or delay of CD in those patients.

Pragmatic language dysfunction in systemic lupus erythematosus patients: Results from a single center Italian study.

BackgroundCognitive impairment (CI) in systemic lupus erythematosus (SLE) is a frequent neuropsychiatric manifestation affecting several domains, even in apparently asymptomatic patients. Current research revealed that the typical CI pattern affects frontal-subcortical circuit and thus executive functions. The impairment of non-literal language or pragmatic language (PL), including metaphors, idioms, inferences or irony has been well described in several conditions such as autism disorders, Parkinson’s disease, brain injury and even in earlier phases of neurodegenerative processes. Even if PL neuro-anatomy remains controversial, correlation between executive dysfunctions and non-literal language involvement has been reported both in traumatic injury and mild cognitive impairment patients. Nonetheless, no specific study has been performed to evaluate PL impairment in SLE patients so far.ObjectivesWe aimed at assessing the PL domain in a Italian monocentric SLE cohort in comparison to healthy controls, matched to age and education, through a specific battery, the batteria sul linguaggio dell'emisfero destro (BLED). Secondly, we focused attention on possible correlations between CI and clinical and laboratory SLE-related features.MethodsForty adult patients affected by SLE, according to the American College of Rheumatology (ACR) criteria, and thirty healthy subjects were enrolled consecutively in this cross-sectional study. The protocol included complete physical examination, extensive clinical and laboratory data collection (comprehensive of demographics, past medical history, co-morbidities, disease activity, chronic damage evaluation, previous and concomitant treatments) and cognitive assessment for five different domains: memory, attention, pragmatic language, executive and visuospatial functions. Self-reported scale for anxiety and depression were performed to exclude the influence of mood disorders on cognitive dysfunction.ResultsWe studied 40 Caucasian SLE patients [male (M)/ female (F) 3/37; mean±standard deviation (SD) age 45.9±10.1 years, mean±SD disease duration 120.8±81.2 months] and 30 healthy subjects (M/F 9/21; mean±SD age 41.3±13 years). According to the low level of disease activity and damage (mean±SD Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) of 1.3±2.3, mean±SD Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) of 0.2±0.5), only 30% of patients was on glucocorticoid treatment at the study entry. PL was the most compromised domain in terms of Mean Domain Z scores. As for the Domain Cognitive Dysfunction score, a deficit of PL was observed in 45% of patients and was significantly more prevalent than memory, executive and visuospatial functions impairment (P = 0.0002, P = 0.0002 and P<0.000001, respectively). According to Global Cognitive Dysfunction score, 25% of patients experienced a mild impairment and 7.5% a moderate one. Anti-phospholipid antibodies positivity was significantly associated with memory impairment (P<0.0005), whereas the presence of other neuropsychiatric events was associated with executive dysfunctions (P<0.05); no further significant association nor correlation were identified.ConclusionIn this study we evaluated for the first time PL in SLE patients finding a dysfunction in almost half of patients. The dysfunction of PL was significantly more frequent than the other domains assessed.

Correlation of Glycemic and Lipid Control Parameters with Cognitive Dysfunction Scores, in Type 2 Diabetic Persons Results from a cross- sectional study

Diabetes-related cognitive dysfunction is considered a long-term complication of diabetes. In this cross-sectional study was studied the relationship between cognitive dysfunction (assessed by using two standardized questionnaires), lipid profile parameters and fatty free acids intake, in outpatients, hospitalized for their periodical control. The Mini-Mental State Exam (MMSE) and The Montreal Cognitive Assessment (MoCA) score were related to the body mass index (BMI), high density cholesterol (HDLc), glycated hemoglobin (Hb A1c) and intake of choline and eicosapentaenoic acid (all Ps [ .05, excepting the relationship between MMSE and HDLc). The implications of FFA intake in dementia development, in type 2 diabetics, is important for disease management and prevention.

Prevention of Cognitive Dysfunction after Cataract Surgery with Intravenous Administration of Midazolam and Dexmedetomidine in Elderly Patients Undergoing Cataract Surgery.

Background:This study aimed to compare the effects of preoperative administration of midazolam and dexmedetomidine on cognitive dysfunction prevention after cataract surgery.Materials and Methods:This research was a double-blind controlled clinical trial. In this study, 150 candidates for cataract surgery under general anesthesia, over 65 years, and similar to American Society of Anesthesiologists I and II characteristics were selected as the sample and randomly assigned to three groups. Participants of these three groups were treated with 0.1 mg/kg of midazolam, 1 μg/kg of dexmedetomidine, and the same volume of normal saline (control), respectively. Hemodynamic parameters and cognitive dysfunction score of the participants were measured using the Mini-Mental State Examination (MMSE) before the surgery, 24 h and 1 week after the surgery.Results:An evaluation of hemodynamic parameters before anesthesia up to 24 h after the surgery showed no significant difference between the midazolam, dexmedetomidine, and control groups in terms of systolic and diastolic blood pressure, heart rate, and blood oxygen saturation (P > 0.05). In addition, there was no statistically significant difference between the midazolam and dexmedetomidine groups in the MMSE score before the surgery and 24 h and 1 week after that (P > 0.05). However, there was a significant difference between these two groups and control (P < 0.05).Conclusion:There was no significant difference between midazolam and dexmedetomidine in reducing postoperative cognitive dysfunction (POCD). However, there is a significant difference between these two groups and control. Hence, either midazolam or dexmedetomidine can be prescribed to reduce POCD in cataract surgeries.

Cognitive dysfunction improves in systemic lupus erythematosus: Results of a 10 years prospective study.

ObjectiveCognitive impairment (CI) has been described in 3–80% of Systemic lupus erythematosus (SLE) patients but only short-term studies evaluated its over-time changes, suggesting that CI is usually a stable finding. We aimed at evaluating the changes of SLE-related CI in a 10-years prospective single center cohort study.MethodsWe evaluated 43 patients (M/F 5/38; mean age = 45.7±10.1 years; mean disease duration = 230.8±74.3 months) at baseline (T0) and after 10 years (T1). A test battery designed to detect fronto-subcortical dysfunction across five domains (memory, attention, abstract reasoning, executive and visuospatial function) was administered. A global cognitive dysfunction score (GCD) was obtained and associated with clinical and laboratory features.ResultsPrevalence of CI was 20.9% at T0 and 13.9% at T1 (P = NS). This impairment was prevalently mild at T0 (55.5%) and mild or moderate at T1 (36.3% for both degrees). After 10 years, CI improved in 50% of patients, while 10% worsened. Impaired memory (P = 0.02), executive functions (P = 0.02) and abstract reasoning (P = 0.03) were associated with dyslipidemia at T0. Worsening of visuospatial functions was significantly associated with dyslipidemia and Lupus Anticoagulant (P = 0.04 for both parameters). Finally, GCD significantly correlated with chronic damage measured by SLICC/damage index at T0 (r = 0.3; P = 0.04) and T1 (r = 0.3; P = 0.03).ConclusionsFor the first time, we assessed CI changes over 10-years in SLE. CI improved in the majority of the patients. Furthermore, we observed an improvement of the overall cognitive functions. These results could suggest that an appropriate management of the disease during the follow-up could be able to control SLE-related CI.

Abstract T MP117: Early Cognitive Dysfunction is Associated With Poor Short Term Functional Outcome in Hospitalized Stroke Patients

Introduction: More than one-half of all patients experience cognitive dysfunction (CD) after stroke, and up to one-third develop dementia. As a Comprehensive Stroke Center, we screen all stroke inpatients for CD, though the feasibility and utility of early screening have not been established. We assessed the hypotheses that early cognitive screening in hospitalized stroke patients is feasible and that early CD is associated with poor short term functional outcome. Methods: The medical records of all patients admitted with ischemic stroke (IS) or intracerebral hemorrhage (ICH) between 2/1/13 and 4/15/13 were reviewed. A Brief Neurocognitive Screening Test assessing registration, delayed recall, fluency, and orientation was performed (4 items from the Montreal Cognitive Assessment, higher score better; maximum 12 points). Patients were eligible if they did not have a medical condition precluding screening (e.g. death, comfort care). Results: Of 303 IS and ICH inpatients, 209 (68.98%) were screened for CD. Over 85% of all eligible patients were screened (87.1% IS and 81.1% ICH). In a multivariate logistic regression model, factors associated with being screened for CD included lower baseline NIHSS (OR 0.91, 95% CI 0.88-0.94) and IS subtype, as compared to ICH subtype (OR 1.97, 95% CI 1.1-3.52). Median scores (IQR) for IS and ICH patients were 8 (3-10) and 5.5 (1.5-9.5), respectively. More than half of all IS and ICH patients (56.94%) screened positive for CD (score &lt; 9). Patients most likely to screen positive for CD included those of older age (OR 1.04, 95% CI 1.02-1.06) and increased NIHSS (OR 1.14, 95% CI 1.08-1.19). Screening positive for CD was associated with poor discharge/day 7 outcome (mRS &gt; 3), independent of age, baseline NIHSS, and stroke subtype (OR 2.37, 95% CI 1.06-5.28). Conclusion: Screening hospitalized stroke patients for CD is feasible and CD in stroke inpatients is common. Older patients and those with more severe strokes are more likely to screen positive. Early CD is associated with poor short term functional outcome. Our results provide preliminary evidence supporting the use of early CD screening in stroke patients. Additional studies on quality of life and long-term outcome are necessary to further assess the utility of early CD screening.

Neuropsychological dysfunction in idiopathic hypoparathyroidism and its relationship with intracranial calcification and serum total calcium

There is limited information on neuropsychological and neurological dysfunctions in patients with idiopathic hypoparathyroidism (IH). To assess neuropsychological and neurological dysfunctions in IH and its associated factors in a cross-sectional design. Neuropsychological functions were assessed in 62 patients with IH and 70 controls using a battery of cognitive tests. Neurological assessment included extrapyramidal and cerebellar signs. Assessment of intracranial calcification and volume of basal ganglia calcification (BGC) were made on computed tomography and of calcium control by averaging serum total calcium values available during the follow-up. A significantly higher proportion of patients with IH showed neuropsychological dysfunctions than controls (32.3 (95% CI: 20.9-45.3) vs 5.7% (95% CI: 1.6-14.0), P<0.001). Neurological signs were present in 35.5% patients (extrapyramidal: 16.1%; cerebellar: 20.9%). Volume of BGC and number of sites with intracranial calcifications including cerebellum/dentate were comparable in patients with and without neuropsychological, extrapyramidal or cerebellar dysfunctions. Cognitive dysfunction score was lower by 1.7 points in males than in females (P=0.02) and increased by 0.21 and 5.5 for each year increase in the duration of illness (P=0.001) and one unit increase in serum calcium-phosphorus product (P=0.01) respectively. The scores improved by 0.27 for every mg% increase in serum calcium (P=0.001). Neuropsychological dysfunctions are present in up to one-third of patients with IH and correlate with duration of illness, female gender, serum calcium and calcium-phosphorus product during follow-up but not with intracranial calcification. These dysfunctions may affect their daily functions, safety and drug compliance.

Neurocognitive dysfunction in systemic lupus erythematosus: association with antiphospholipid antibodies, disease activity and chronic damage.

IntroductionSystemic lupus erythematosus (SLE) is characterized by frequent neuropsychiatric involvement, which includes cognitive impairment (CI). We aimed at assessing CI in a cohort of Italian SLE patients by using a wide range of neurocognitive tests specifically designed to evaluate the fronto-subcortical dysfunction. Furthermore, we aimed at testing whether CI in SLE is associated with serum autoantibodies, disease activity and chronic damage.MethodsFifty-eight consecutive patients were enrolled. Study protocol included data collection, evaluation of serum levels of ANA, anti-dsDNA, anti-cardiolipin, anti-β2-glycoprotein I, anti-P ribosomal, anti-endothelial cell, and anti-Nedd5 antibodies. SLEDAI-2000 and SLICC were used to assess disease activity and chronic damage. Patients were administered a test battery specifically designed to detect fronto-subcortical dysfunction across five domains: memory, attention, abstract reasoning, executive function and visuospatial function. For each patient, the raw scores from each test were compared with published norms, then transformed into Z scores (deviation from normal mean), and finally summed in the Global Cognitive Dysfunction score (GCDs).ResultsNineteen percent of patients had mild GCDs impairment (GCDs 2–3), 7% moderate (GCDs 4–5) and 5% severe (GCDs≥6). The visuospatial domain was the most compromised (MDZs = −0.89±1.23). Anti-cardiolipin IgM levels were associated with visuospatial domain impairment (r = 0.331, P = 0.005). SLEDAI correlated with GCDs, and attentional and executive domains; SLICC correlated with GCDs, and with visuospatial and attentional domains impairment.ConclusionsAnti-phospholipids, disease activity, and chronic damage are associated with cognitive dysfunction in SLE. The use of a wide spectrum of tests allowed for a better selection of the relevant factors involved in SLE cognitive dysfunction, and standardized neuropsychological testing methods should be used for routine assessment of SLE patients.