Cognitive Function In Elderly Patients Research Articles

STAM protocol in dementia: a multicenter, single-blind, randomized, and controlled trial.

The Sound Training for Attention and Memory in Dementia (STAM-Dem) is a manualized music-based protocol designed to be used in the rehabilitation of cognitive functions in elderly patients with dementia (PWD). This was a multicenter, single-blind, randomized, and controlled trial that involved 51 PWD. The objective was to test the STAM-Dem efficacy. Patients in the experimental group followed the STAM-Dem for 2 weekly sessions of 45 minutes for 12 weeks (in addition to standard care). Those in the control group continued with the normal "standard care" provided. In the experimental group, the instruments immediate prose memory test (MPI), deferred prose memory test (MPD), attentional matrices, activities of daily living, Music Therapy Activity Scale (SVAM) and Geriatric Music Therapy Profile (GMP) increase significantly from pre to post-test (P < .05). The protocol is feasible and data suggest that there was an effect on attentino (matrices) and prose memory skills (MPI and MPD). The effect size reveals a general improvement in the results of the experimental group.

The impact of ondansetron on postoperative cognitive function in elderly patients undergoing surgery under general anaesthesia due to femoral fracture - preliminary data

The impact of ondansetron on postoperative cognitive function in elderly patients undergoing surgery under general anaesthesia due to femoral fracture - preliminary data

Association Between the Apolipoprotein E4 and Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Intravenous Anesthesia and Inhalation Anesthesia

BACKGROUND Intravenous and inhalation anesthesia are commonly used in the clinical setting. Recovery of cognitive function in elderly patients after surgery has received increased attention. In this study, the authors compared recovery of cognitive function in patients after different anesthesia techniques, and investigated which technique is safer. The authors also explored association between apolipoprotein E4 and postoperative cognitive dysfunction in patients undergoing general anesthesia. METHODS A total of 2,000 patients were equally and randomly divided into intravenous and inhalation anesthesia groups. Total intravenous and inhalation anesthesia were used. Within 10 days after surgery, cognitive function was assessed daily using the Mini-Mental State Examination (MMSE). Restriction fragment length polymorphism of apolipoprotein E gene was analyzed. The primary outcome was MMSE score, frequency distribution of apolipoprotein E alleles and genotypes. P < 0.01 was used as statistically significant. RESULTS MMSE score in inhalation preoperative baseline group significantly decreased at day 3 after surgery compared with the preoperational and intravenous anesthesia group. The proportion of patients scoring less than 25 points was significantly greater in the inhalation anesthesia group than in the intravenous anesthesia group at 3 days after surgery. In the inhalation anesthesia group, the decrease in MMSE score was closely related with apolipoprotein E e4 allele. In the intravenous anesthesia group, the decrease in MMSE score was not correlated with apolipoprotein E e4 allele. CONCLUSIONS There was a strong association between the apolipoprotein E e4 and postoperative cognitive dysfunction in elderly patients undergoing inhalation anesthetics.

Early benefit of preserved cognitive function is not sustained at one-year after cardiac surgery: a longitudinal follow-up of the randomized controlled trial

Recently, we showed that processing of shed blood with a continuous-flow cell saver during cardiopulmonary bypass resulted in a clinically significant reduction in postoperative cognitive decline (POCD) six weeks after coronary artery bypass graft (CABG) surgery. The current study examined if the early benefit of reduced POCD was sustained in the same patient population at one-year follow-up. One hundred seventy patients (cell saver group, n = 84; controls, n = 86) underwent neuropsychological testing at baseline and one year after surgery. The raw scores for each test were converted to Z-scores, and a combined Z-score of ten main variables was then calculated for each study group. Postoperative cognitive decline was present in 16 of 84 (19%) patients in the cell saver group (95% confidence interval [CI], 10.8 to 27.2) vs 15 of 86 (17.4%) patients in the control group (95% CI, 9.6 to 25.2) (P = 0.786). Six of the 15 patients in the control group with POCD at six weeks had the impairment at one year and five did not; four were lost to follow-up. Three of the six cell saver patients with POCD at six weeks still had impairment at one year, two did not, and one was not tested. Thirteen (15.4%) and nine (10.5%) patients in the cell saver and control groups, respectively, developed new POCD which was not evident at the six-week follow-up. The short-term preservation of cognitive function in elderly patients using the cell saver management strategy did not translate into a long-term benefit one year after CABG surgery. The presence of progressing cerebrovascular disease may be responsible for the long-term cognitive decline.

Association between the Apolipoprotein E4 and Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Intravenous Anesthesia and Inhalation Anesthesia

Intravenous and inhalation anesthesia are commonly used in the clinical setting. Recovery of cognitive function in elderly patients after surgery has received increased attention. In this study, the authors compared recovery of cognitive function in patients after different anesthesia techniques, and investigated which technique is safer. The authors also explored association between apolipoprotein E4 and postoperative cognitive dysfunction in patients undergoing general anesthesia. A total of 2,000 patients were equally and randomly divided into intravenous and inhalation anesthesia groups. Total intravenous and inhalation anesthesia were used. Within 10 days after surgery, cognitive function was assessed daily using the Mini-Mental State Examination (MMSE). Restriction fragment length polymorphism of apolipoprotein E gene was analyzed. The primary outcome was MMSE score, frequency distribution of apolipoprotein E alleles and genotypes. P < 0.01 was used as statistically significant. MMSE score in inhalation preoperative baseline group significantly decreased at day 3 after surgery compared with the preoperational and intravenous anesthesia group. The proportion of patients scoring less than 25 points was significantly greater in the inhalation anesthesia group than in the intravenous anesthesia group at 3 days after surgery. In the inhalation anesthesia group, the decrease in MMSE score was closely related with apolipoprotein E ε4 allele. In the intravenous anesthesia group, the decrease in MMSE score was not correlated with apolipoprotein E ε4 allele. There was a strong association between the apolipoprotein E ε4 and postoperative cognitive dysfunction in elderly patients undergoing inhalation anesthetics.

Effect of reminiscence therapy on cognitive function of elderly patients with mild cognitive impairment

Objective To explore the effects of reminiscence therapy on cognitive function of elderly patients with mild cognitive impairment (MCI).Methods 40 elderly patients with MCI were randomly divided into test group (n=20) and control group (n=20). The control group was only given the general care; besides the general care, the test group was given reminiscence therapy for 4 months. The effects were evaluated with Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MOCA) and Activities of Daily Living (ADL).Results After 4 months, there was significant difference between both groups in the scores of MMSE, MOCA and ADL (P 0.05). MOCA, ADL scores were significantly better than those before the intervention in the test group (P<0.05), but there was no significant difference in MMSE scores compared with that before the intervention.Conclusions Reminiscence therapy could improve cognitive function of elderly patients with MCI. Key words: Mild cognitive impairment; Cognitive function; Elderly; Reminiscence therapy

Damaged Proteins Bearing L-Isoaspartyl Residues and Aging: A Dynamic Equilibrium Between Generation of Isomerized Forms and Repair by PIMT

Proteins are susceptible to numerous non-enzymatic post-translational modifications which occur both during normal aging and in neurodegenerative states. For instance, formation of abnormal L-isoaspartyl residues arising from both the deamidation of L-asparaginyl residues and the isomerization of L-aspartyl residues is a frequent chemical modification that affects proteins. The formation of L- isoaspartyl residues in proteins alters their three-dimensional structure leading usually to a loss of function. Notably, accumulation of isomerized proteins could contribute to metabolic dysfunctions in neuronal cells during aging reducing cognitive functions in elderly patients and would eventually promote the development of neurodegenerative diseases. The protein L-isoaspartyl (D-aspartyl) methyltransferase (PIMT) is an enzyme that recognizes and repairs the abnormal L-isoaspartyl residues in proteins. Its expression appears to decline during aging which could partially explain the build up of damaged proteins in old age. In this review, we summarize recent findings, based mostly on proteomic data, regarding the formation and accumulation of proteins bearing atypical L-isoaspartyl residues as well as PIMT functions during normal aging and in some neurodegenerative diseases. The emphasis is on possible molecular mechanisms controlling PIMT expression and the ability of PIMT to repair isomerized substrates during aging. Investigation of processes regulating age-related accumulation of isomerized proteins is a promising avenue to a better understanding of aging at the protein level. Keywords: Aging, Damaged proteins, L-isoaspartyl residues, PIMT, deamidation, L-asparaginyl residues, L-aspartyl residues, neurodegenerative diseases, lipid peroxidation, oxidation, glycation, isomerization, racemization, A-crystallin, protein kinase A (PKA), fibronectin, v3-integrin binding, monomeric enzyme, alanine, proteomic analysis, immunobloting, brain cytosol, hemodialysis fluid, cerebrospinal fluid, amniotic fluid, methylation, cortex, hippocampus, hypothalamus, striatum, immunochemical analysis, thalamus, amygdala, methamphetamine, epilepsy, cerebellum, schizophrenia, Huntington's disease, methyltransferase, synaptosomes, synuclein, Parkinson's disease, synuclein fibrils, Lewy bodies, immunohistochemistry, immunoreactivity, lymphocytes, methyl acceptor proteins, tubulin, insulin-like growth factor-I (IGF-I), estradiol, valproic acid, lysosomes, proteasomal activity, Alzheimer's disease, dementia, intraneuronal neurofibrillary tangles, amyloid (A) peptide, autopsy, cortical neuritic plaques, amyloid plaques

Damaged Proteins Bearing L-Isoaspartyl Residues and Aging: A Dynamic Equilibrium Between Generation of Isomerized Forms and Repair by PIMT

Proteins are susceptible to numerous non-enzymatic post-translational modifications which occur both during normal aging and in neurodegenerative states. For instance, formation of abnormal L-isoaspartyl residues arising from both the deamidation of L-asparaginyl residues and the isomerization of L-aspartyl residues is a frequent chemical modification that affects proteins. The formation of L- isoaspartyl residues in proteins alters their three-dimensional structure leading usually to a loss of function. Notably, accumulation of isomerized proteins could contribute to metabolic dysfunctions in neuronal cells during aging reducing cognitive functions in elderly patients and would eventually promote the development of neurodegenerative diseases. The protein L-isoaspartyl (D-aspartyl) methyltransferase (PIMT) is an enzyme that recognizes and repairs the abnormal L-isoaspartyl residues in proteins. Its expression appears to decline during aging which could partially explain the build up of damaged proteins in old age. In this review, we summarize recent findings, based mostly on proteomic data, regarding the formation and accumulation of proteins bearing atypical L-isoaspartyl residues as well as PIMT functions during normal aging and in some neurodegenerative diseases. The emphasis is on possible molecular mechanisms controlling PIMT expression and the ability of PIMT to repair isomerized substrates during aging. Investigation of processes regulating age-related accumulation of isomerized proteins is a promising avenue to a better understanding of aging at the protein level.

The effect of ulinastatin on postoperative cognitive function in elderly patients after sevoflurane inhalation anesthesia

Objective To research the effect of regulating systemic inflammatory response by using ulinastatin in elderly patients after sevoflurane inhalation of postoperation cognitive function. Methods 60 patients under went elective abdominal surgery, were randomly double-blinded divided into 2 groups. Every group had 30 patients.Group A accepted continuously intravenousiy infusion ulinastatin 2000 units · kg-1 · h-1 , while group B got equivalent continuously intravenous infusion 0.9% sodium chloride injection. The time point of opening eye, extubation, response and the mini-mental state examination(MMSE) score on different time points were observed. Meanwhile, the changes of concentration of hs-CRP, IL-6,IL-10 were measured. Results Compared with two groups,group A has shorter time on response(F =4.399,P = 0.040). Two both groups had decrease of MMSE score 1 hour after surgery compared with preoperation(t =7. 732,11. 916, both P ＜ 0.01), and the score were less than the preoperative value of more than 2 points which showed cognitive decline in patients. But group A's rate of decline in MMSE score was lower than group B(F = 7. 582 ,P =0.012). Both groups had the MMSE score decline 6h after surgery (t = 4. 606,8. 615, both P ＜ 0.05). Group A's score was less than the preoperative value for less than 2 points, group B's score was lower than the preoperative value for more than 2 points, but the difference between the two groups was not significant (P ＞0. 05). Both groups had higher concentrations of hs-CRP、IL-6 、IL-10 at postoperative 1 d ,3d ,7d (all P ＜ 0.01), peaked at postoperative 1 d, and hadn't come back to the preoperative level 7d*after surgery. In group A, the concentrations of hs-CRP, IL-6 increased (postoperative 1 d,3d), but the rate was lower than the group B (F = 14. 885, P = 0.000;F = 4. 405, P = 0. 040; F = 18. 204, P = 0.000; F = 8. 074, P = 0. 006); while the increased rate of concentration of IL-10 was higher than the group B(F=5.197,P=0.026;F= 12.236,P =0.000). Conclusion Ulinastatin could promote the elderly after sevoflurane inhalation rapid recovery of cognitive function, which may be related to the regulation of systemic inflammatory response. Key words: Ulinastatin; Inflammatory factor; Sevoflurane; Cognitive function; Aged

Factors Associated with Cognitive Decline in Elderly Diabetics

Background/Aims: Although recent evidence has indicated that type 2 diabetes mellitus (T2DM) in the elderly is a risk factor for cognitive dysfunction or dementia, few studies have prospectively observed this potential cognitive decline. In the current study, we performed cognitive assessments at baseline and after 3 years in the same patient group in an attempt to reveal the contributions of diabetes-related factors to the increased decline in cognitive function in elderly patients with T2DM. Methods: We recruited 55 consecutive T2DM patients with a Mini-Mental State Examination (MMSE) score ≧24 from the Diabetic Center at the Chubu Rosai Hospital. These patients ranged in age from 65 to 85 years. Cognitive and clinical assessments, including brain MRI, were performed at baseline and at the 3-year follow-up. Results: The higher plasma insulin and HbA_1c levels observed at baseline were significantly associated with a worse cognitive performance at baseline and a more neurocognitive decline at the follow-up visit. Conclusion: The current prospective study suggests that higher insulin and glycohemoglobin levels may be associated with diabetes-related cognitive dysfunction.

Behandlungsqualität bei geriatrischen Patienten mit Diabetes mellitus in verschiedenen häuslichen Versorgungsstrukturen

The goal of the present study was to systematically assess treatment quality, perceptions, and cognitive function of elderly patients with diabetes admitted to an acute geriatric hospital from different home environments (nursing home residents, home care, assisted living, family caregivers, self-sufficient). Quality of diabetes treatment, metabolic control (HbA(1c)), nutrition, treatment satisfaction, cognition, disability, and level of dependency were assessed in 128 patients with diabetes. Out of 128 patients, 87 patients (68%) showed an HbA1c≤8% according to the guidelines for aging people with diabetes of the German Diabetes Association (DDG). Compared to patients living independently at home, the metabolic control in nursing home residents and their treatment satisfaction were as good. They had a higher degree of dependency though (Barthel, p<0.001), more strongly impaired mobility (Tinetti, p<0.01), less diabetes knowledge (p<0.001), inferior cognitive performance (MMSE, SPMSQ, p<0.01), and a higher prevalence of depression (GDS) (p<0.01). Better cognitive function correlated with better diabetes knowledge (r=0.49; p<0.001), but not with better metabolic control. The treatment of geriatric patients with diabetes mellitus requires individual considerations and interdisciplinary care. Particularly the continuing education of geriatric nurses could contribute to improved diabetes treatment quality in nursing home residents.

Journal Digest

Journal Digest

The relationship between the depressive symptoms and congnitive funcion of eldrly patients

Objective To analyze depressive symptoms and its relationship with cognitive function of elderly patients in mental hospital.Methods To investigate 221 cases of elderly patients aged more than 60 years old selected from Yiwu third people's hospital and were screened by Chinese version of center of epidemiological survey depression scale (CES-D) and Chinese version of mini-mental states examination (MMSE).Results (1)153 cases (69.2%) of elderly patients suffer from definite depression symptoms.(2) The depressive symptoms of elderly patients,with different age,sex,educational level,have no significant difference.(3)The depressive symptoms have relationship with their cognitive function impairment on elder patients.Conclusion Routine screening for depressive symptoms and cognitive function is necessary for elderly patient with depressive or cognitive function impairment. Key words: Depression; Cognition; Aged

10.5 Blood Pressure and Cognitive Function in Elderly Patients with Diabetes Mellitus Type 2

10.5 Blood Pressure and Cognitive Function in Elderly Patients with Diabetes Mellitus Type 2

Review of Normative Data For Common Screening Measures Used to Evaluate Cognitive Functioning in Elderly Individuals

When conducting neuropsychological evaluations of the elderly, it is important to compare patients' test scores to appropriate normative data to maximize diagnostic and descriptive accuracy. Many sets of normative data are now available for screening measures that assess cognitive functioning in the elderly. This article systematically reviewed available norms for 6 widely used screening measures of cognitive functioning in elderly patients. Details regarding the sample characteristics and data collection methods are provided for each set of norms, thereby providing a useful reference for clinicians.

The use of atorvastatin and ezetimibe in the SPACE trial has rocketed hopes for improved cognitive functioning in elderly patients with atrial fibrillation

The use of atorvastatin and ezetimibe in the SPACE trial has rocketed hopes for improved cognitive functioning in elderly patients with atrial fibrillation

Cognitive Impairment in Late-Life Generalized Anxiety Disorder

This study sought to characterize cognitive functioning in elderly patients with generalized anxiety disorder (GAD), as compared with normal comparison subjects and patients with major depression. The cognitive functioning in GAD (N=19) was assessed with the Mattis Dementia Rating Scale and across specific domains of naming, executive ability, and memory, in comparison with late-life major depressive disorder (MDD; N=68) and versus no psychiatric illness (N=40). In comparison to healthy normal comparison subjects, anxious subjects were impaired on measures of short-term and delayed memory. Depressed subjects also performed worse than normal comparison subjects on delayed memory, as well as in naming. Anxious subjects did not differ significantly from depressed subjects in any measure of cognitive function. In this preliminary study, anxious subjects displayed cognitive impairments in short-term memory; while depressed patients compared to normal comparison subjects showed executive dysfunction and more general cognitive impairments not evident in anxious subjects. Studies of neuropsychological function in elderly anxious subjects may be informative in developing treatment interventions that mitigate cognitive dysfunction and illuminate the course of illness and underlying neural pathways.

Effects of GH on cognitive function in elderly patients with adult-onset GH deficiency: a placebo-controlled 12-month study

Young adults with childhood-onset GH deficiency (GHD) have reduced memory and attention, which can be improved by treatment with GH. Little information is available on cognitive function in elderly GHD patients. Single center, double-blind, randomized, placebo-controlled study of 52-week duration. Elderly GH therapy naïve GHD patients (n=34; age range 60-77 years) were enrolled and randomized to receive placebo or GH therapy which was titrated to achieve a target IGF-I level of +1 to +2 s.d. of the normal mean for age. Cognitive function was assessed at baseline and after 24 and 52 weeks, using a computerized psychometric test package (Neurobehavioral Examination System-2). The mean GH dose was 0.16+/-0.06 mg/day; mean IGF-I increased from 135+/-59 ng/ml at baseline to 213+/-77 ng/ml during active treatment. The GH-treated group had better mean serial digit learning scores compared with placebo group (P<0.05). Assessment of effect sizes showed that improvements in memory occurred with GH after 24 weeks. The overall adverse event rates were similar in the GH and the placebo group. This study indicates that GH replacement may be accompanied by improvement in certain measures of cognitive function in elderly patients with GHD.

Cognitive functioning in elderly patients with early onset bipolar disorder

Very little is known about the long term cognitive sequelae of bipolar disorder. To investigate neuropsychological functioning in older euthymic persons with early onset bipolar disorder. Fifteen older patients (age >60) with an early onset (<50 years) bipolar-I disorder in a euthymic mood were tested using a comprehensive neuropsychological test battery. Neuropsychological functioning was compared with that of a sex, age and education-matched group of 15 comparison subjects without mood disorders or memory complaints. Bipolar subjects scored lower than comparison subjects on selective attention, verbal memory, verbal fluency and mental effort tests. The findings suggest that euthymic bipolar patients are impaired across a range of cognitive domains. This could represent a trait-like cognitive disability related to the disease, as the impairments are comparable with those found in younger bipolar patients.

The effects of tramadol on pain relief, fast EEG-power spectrum and cognitive function in elderly patients with chronic osteoarthritis (OA)

Summary Pain and cognitive impairment in the elderly patient with osteoarthritis (OA) often is managed inadequately with common NSAIDs. We therefore evaluated the opioid-like agent tramadol, preportedly also acting as a monaminergic reuptake inhibitor. Patients (75 years ± 7S.D.; 17 female, 2 male) with chronic OA of the knee, elbow, shoulder and hip complaining of acute pain were given two 50 mg/70 kg oral doses of tramadol 30 min apart. Before, during and 2 h after medication, the following parameters were measured: 1. Heart rate (HR) and blood pressure (BP). 2. Visual analogue scaling (VAS) of pain associated with movement. 3. Relative changes in the EEG-power spectra (δ, θ, α, β) to control, over a 60 s period. 4. Cognitive function using the Sandoz Clinical Assessment Geriatric scale (SCAG). Patients experienced a significant (p In addition to pain relief, tramadol also improved mood, the ability to perform tasks and reversed disability in cognitively impaired elderly. Subsequent to this pilot trial further studies of tramadol in the elderly are warranted.