Profile Of Cognitive Impairment Research Articles

B - 74 The Effect of Perimenopause on Women’s Executive Functioning: a Systematic Review

Abstract Objective This systematic review aims to examine the existing literature on the impact of perimenopause/menopause on cognitive function, identify overlaps with adult ADHD symptoms, and provide evidence-based recommendations for distinguishing between the two conditions, guiding clinical practice and identifying considerations for selection of neuropsychological testing with this population. Data Selection A search of electronic databases, including PubMed, PsycINFO, and MEDLINE, will be conducted to identify relevant peer-reviewed studies published between 2000 and 2024. Studies examining cognitive changes during perimenopause/menopause, diagnostic challenges in distinguishing perimenopause/menopause-related cognitive decline from adult ADHD symptoms, and interventions for accurate assessment and management will be included. Data extraction and synthesis will be performed following PRISMA guidelines. Data Synthesis The analysis will review a range of literature on the cognitive changes associated with perimenopause/menopause, including deficits in attention, memory, and executive function, which may overlap with symptoms of adult ADHD. Attention will be paid to looking for distinct patterns of cognitive impairment and hormonal profiles between perimenopause/menopause-related cognitive decline and adult ADHD. Various screening tools and neuropsychological assessments will be examined for their utility in differentiating between the two conditions. Conclusions The current systematic review, with its focus on the impact of menopause and perimenopause on women’s cognitive functioning, particularly executive functioning, has the potential to significantly advance our understanding in this area. It will be able to provide clinical recommendations and considerations for individuals administering and interpreting neuropsychological testing with this population. Recommendations for best practices will be proposed, potentially revolutionizing the way we approach and manage these conditions.

Profiling people with Parkinson's disease at risk of cognitive decline: Insights from PPMI and ICICLE-PD data.

A subset of people with Parkinson's disease (PD) develop dementia faster than others. We aimed to profile PD cognitive subtypes at risk of dementia based on their rate of cognitive decline. Latent class mixed models stratified subtypes in Parkinson's Progression Markers Initiative (PPMI) (N=770) and ICICLE-PD (N=212) datasets based on their decline in the Montreal Cognitive Assessment over at least 4 years. Baseline demographic and cognitive data at diagnosis were compared between subtypes to determine their clinical profile. Four subtypes were identified: two with stable cognition, one with steady decline, and one with rapid decline. Performance on Judgement of Line Orientation, but not category fluency, was associated with a steady decline in the PPMI dataset, and deficits in category fluency, but not visuospatial function, were associated with a steady decline in the ICICLE-PD dataset. People with PD susceptible to cognitive decline demonstrate unique clinical profiles at diagnosis, although this differed between cohorts. Four cognitive subtypes were revealed in two Parkinson's disease samples.Unique profiles of cognitive impairment were related to cognitive decline.Judgement of Line Orientation/category fluency predictive of steady decline.Global deficits related to rapid cognitive decline and increased dementia risk.

Sex differences in neurocognitive performance in older adults with bipolar disorder

IntroductionIn recent years, research has focused on the older adults with bipolar disorder (OABD), aged 50 years and over, a constantly growing population due to the increased of life expectancy. Actually, some authors suggest that these individuals constitute a distinct subtype with a specific and different needs such as seen in epidemiologic, clinical and cognitive features. Further research has revealed significant differences between females and males with BD in clinical and cognitive variables in middle-aged and young patients, but this topic among OABD population remains unclear.ObjectivesThe aim of this study is to identify the distinctive profile in clinical, functional and neurocognitive variables between females and males in OABD.MethodsA sample of OABD and Healthy Controls (HC) were included. Euthymic patients or in partial remission were included. Neurocognition was measured with a battery of tests that included premorbid intelligence quotient, working memory, verbal and visual memory, processing speed, language and executive functions. Independent t-test and Chi-squared test analysis were performed as appropriated.ResultsAccording to the analysis, statistically significant differences were seen between females and males. A more impaired cognitive profile is observed in women. They performed worse in the subscales of Arithmetic (F= 6.728, p = <0.001), forward digits (F= 0.936, p= 0.019) and Total Digits (F= 1.208, p= 0.019) of the WAIS-III, in the Stroop Color Word Test, color reading (F= 0.130, p= < 0.001), in the Continuous Performance Test, block change measure (F= 2.059, p= 0.037), in the Rey-Osterrieth Complex Figure-copy (F= 0.005, p= 0.029) and in the Boston Naming Test (F= 0.011, p= 0.024). Nor significant differences were found in clinical neither in psychosocial functioning variables.ConclusionsIn view of the following results, and since no differences were observed between women and men in terms of clinical and functional outcomes, it could be said that the differences observed in cognition cannot be explained by disease-related factors. Furthermore, these results highlight the need to develop a gender-specific cognitive interventions in OABD population. In this way, we could have an impact on the course of the illness to reach a better quality of life.Disclosure of InterestS. Martín-Parra: None Declared, C. Torrent Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00344) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIIISubdireccion General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), A. Ruiz: None Declared, M. Bort: None Declared, G. Fico Grant / Research support from: Fellowship from “La Caixa” Foundation (ID 100010434 - fellowship code LCF/BQ/DR21/11880019), V. Oliva: None Declared, M. Prisco: None Declared, J. Sanchez-Moreno Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), E. Jimenez Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), A. Martinez-Aran: None Declared, E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI18/ 00805, PI21/00787) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357; the European Union Horizon 2020 research and innovation program (EU.3.1.1. Understanding health, wellbeing and disease: Grant No 754907 and EU.3.1.3. Treating and managing disease: Grant No 945151), B. Sole: None Declared, L. Montejo: None Declared

Cognitive impairment and neurocognitive profiles among people living with HIV and HIV-negative individuals older over 50 years: a comparison of IHDS, MMSE and MoCA.

We aimed to examine the l differences in the assessment of neurocognitive impairment (NCI) using cognitive screening tools between PLWH and HIV-negative individuals and further compare the neurocognitive profiles between the two groups. This was baseline evaluation of Pudong HIV Aging Cohort, including 465 people living with HIV (PLWH) and 465 HIV-negative individuals aged over 50 years matched by age (± 3 years), sex and education. NCI was assessed using the Chinese version of Mini-mental State Examination (MMSE), the International HIV Dementia Scale (IHDS) and Beijing version of Montreal Cognitive Assessment (MoCA). In total, 258 (55.5%), 91 (19.6%), 273 (58.7%) of PLWH were classified as having NCI by the IHDS, MMSE and MoCA, compared to 90 (19.4%), 25 (5.4%), 135 (29.0%) of HIV-negative individuals, respectively (p < 0.05); such associations remained significant in multivariable analysis. PLWH showed a larger overlap of NCI detected by IHDS, MMSE, and MoCA. IHDS and MoCA detected almost all of the NCI detected by MMSE. IHDS-motor and psychomotor speeds and MoCA-executive function showed the greatest disparities between two groups. In multivariable analysis, older age and more depressive symptoms were positively associated with NCI regardless of the screening tools or HIV serostatus. PLWH over 50 years old display a higher prevalence of NCI and distinct neurocognitive profiles compared to HIV-negative individuals, despite viral suppression. Given the more considerable overlap in NCI classification in PLWH, it is advisable to choose one screening tool such as IHDS or MoCA to identify those potentially having NCI and then refer to more comprehensive neuropsychological assessment.

Cognition, depression, and functional health profiles (CoDe-F) of non-debilitated aged in the coastal belt of southern India: An explorative study at homes for the aged

IntroductionCognitive function, depression, and functional health profiles of older adults directly predict overall well-being. Family dynamics in India are changing mainly due to urbanization, migration of the younger generation for education or employment, and change in the social system, making the elderly parents alone and slowly getting transferred to old age homes. Hence, the investigators were interested in determining the functional health, depression, and cognitive decline among young and middle-aged non-debilitated institutionalized older adults. ObjectivesTo determine the correlation between cognitive function and depression among the young-old and old-old elderly and determine the functional health profiles of non-debilitated older adults residing at the old age homes of the coastal part of southern India. Study designAn exploratory study at the homes for the aged. MethodologyThe survey was conducted at old age homes after obtaining permission from the respective authorities. Socio-demographic proforma, functional health profiles, Modified Barthel Index, Short-form depression scale, and Muscle strength assessments were the data collection instruments. Statistical Analysis was done through Jamovi. (Version 2.3). Descriptive statistics and Karl Pearson's parametric statistic test were applied. ResultsMontreal's cognitive assessment revealed that 81% of the elderly had borderline cognitive impairment. The short-form geriatric depression score revealed that 87% reported mild depressive symptoms. As cognitive ability declined, depressive symptoms were common among institutionalized older adults (r = −0.494, p < 0.05) ConclusionDepression, cognitive impairment, and functional health profiles of older adults residing at old age homes need to be monitored regularly, and appropriate interventions must be employed to improve their quality of life.

Moving across disorders: A cross-sectional study of cognition in early onset ataxia and dystonia

BackgroundEarly onset ataxia (EOA) and Early Onset Dystonia (EOD) are movement disorders developing in young people (age <25 per definition). These disorders result from dysfunctional networks involving the cerebellum and basal ganglia. As these structures are also important for cognition, cognitive deficits can be expected in EOA and EOD. EOA and EOD sometimes co-occur, but in those cases the predominant phenotype is determining. A pending question is whether predominantly EOA and EOD have different profiles of cognitive impairment. ObjectivesWe investigated whether cognitive functions were impaired in patients with either predominant EOA or predominant EOD and whether cognitive profiles differed between both patient groups. MethodsThe sample consisted of 26 EOA and 26 EOD patients with varying etiology but similar duration and severity of the disorder. Patient samples were compared to a group of 26 healthy controls, all matched on age and gender. All participants underwent neuropsychological testing for verbal intelligence, memory, working memory, attention/cognitive speed, executive functions, emotion recognition and language. ResultsEOA and EOD patients both performed significantly worse than healthy controls on tests of verbal intelligence, working memory and executive functions. Additionally, attention/cognitive speed and emotion recognition were impaired in the EOA group. Compared to EOD, EOA patients performed worse on attention/cognitive speed and verbal intelligence. ConclusionsOur results show overall similar profiles of cognitive deficits in both patient groups, but deficits were more pronounced in the patients with EOA. This suggests that more severe cognitive impairment is related to more severe cerebellar network dysfunction.

Cognitive Profiles of Mild Traumatic Brain Injury and mild Vascular Cognitive Impairment: A Comparative Study

Abstract Objective The cognitive profile of any neurological disorder is very important throughout the duration of a person's treatment. It has a role in diagnosis, prognosis, and even after remission of active symptoms. It is a common trend among clinicians to monitor and compare the cognitive profiles of different disease conditions to locate the area of maximum dysfunction, with respect to a particular diagnosis. This study correlates the cognitive profiles of mild traumatic brain injury (mTBI) and mild vascular cognitive impairment (mVCI). Methods The study population comprised 30 mTBI and 30 mVCI patients medically diagnosed by a neurologist. The patients were been selected from the neuromedical outpatient department (OPD) and neurosurgery OPD of the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum. Simple random sampling had been used to select the sample. The patients diagnosed with the stated disease conditions were referred for neuropsychological assessment. Testable and cooperative patients were recruited for the study. To stabilize the data and for a transparent comparison, 30 healthy controls with no medically diagnosed illnesses were also added to the study. The results were analyzed using R. Result and Conclusion The study concluded that cognitive profiles of mTBI and mVCI patients were significantly different from the cognitive profiles of healthy controls, but there was no statistically significant difference between the cognitive profiles of mVCI and mTBI patients except in confrontation naming and recognition memory.

Presymptomatic Profiles of Cognitive Impairment with Prior Mobility Impairment

ObjectivesTo identify cognitive and health profiles of cognitively impaired older adults with the presence of prior mobility impairment, which may represent a specific pathway to the development of cognitive impairment or dementia. DesignRetrospective longitudinal study. Setting and ParticipantsIn adults aged ≥65 years who developed cognitive impairment or dementia, we compared cognitive and health profiles of those who did (n = 57) and did not (n = 86) experience slow gait up to 14 years before symptom onset. Measures of cognitive and biomarkers assessed longitudinally over an average of 7 years before symptom onset were compared between groups using linear mixed effects models, adjusted age, sex, race, and additionally adjusted for education for cognitive outcomes. ResultsCompared to those without prior slow gait, those with slow gait had lower Digit Symbol Substitution Test and Pegboard dominant and nondominant hand performance. The slow gait group also had greater body mass index (BMI), waist, systolic blood pressure, lower high-density lipoprotein and low-density lipoprotein, and lower lysophosphatidylcholine 18:2, a lipid associated with mitochondrial function, and showed greater increases in 2-hour glucose levels of an oral glucose tolerance test. The slow gait group was more likely to take medication for hypertension and hypercholesterolemia. Conclusions and ImplicationsDuring the presymptomatic stage, cognitively impaired older persons who experience prior slow gait are more likely to have deficits in psychomotor speed and manual dexterity, an unfavorable metabolic and vascular profile, and lower lipid levels related to mitochondrial function. Older persons who exhibit mobility impairment should be evaluated for metabolic and vascular dysfunction at an early stage, and successful treatment of these conditions may slow down the progression of cognitive impairment or dementia.

Profiles of physical frailty, social frailty, and cognitive impairment among older adults in rural areas of China: a latent profile analysis.

As China rapidly ages, it has now become a deeply aging society with the largest number of older individuals in the world. The issue is particularly severe in rural areas. With the aging population growing and the older population expanding, health problems are becoming more prevalent among older individuals, particularly frailty and cognitive impairments. This study aimed to identify the profiles of physical frailty, social frailty, and cognitive impairment among older adults and explore the influencing factors. In this cross-sectional study, participants were recruited from six villages in four cities in Shandong Province, China from July to October 2023 through cluster random sampling. Latent profile analysis was used to determine the profiles of physical frailty, social frailty, and cognitive impairment. Chi-square tests and Mann-Whitney U tests were used for univariate analysis, while binary logistic regression was used to analyze the related factors. Seven hundred and sixty-nine older adult care in rural areas showed two profiles: the "high cognitive function and low frailty" group (73.7%, n = 567) and the "low cognitive function and high frailty" group (26.3%, n = 202). A binary logistic regression found that older people were more likely to be aged 80 or older (OR = 2.253, p = 0.029), have a low income level (OR = 1.051, p = 0.007), have one or two (OR = 2.287, p = 0.004), or more than three chronic diseases (OR = 3.092, p = 0.002), and report moderate (OR = 3.406, p = 0.024) or poor health status (OR = 9.085, p < 0.001) in the "low cognitive function and high frailty" group. Meanwhile, older adults who have completed high school (OR = 0.428, p = 0.005) or junior college and above (OR = 0.208, p = 0.009), and engage in adequate physical activity (OR = 0.319, p < 0.001) were more likely to be in the "high cognitive function and low frailty" group. In the future, medical professors should increasingly prioritize promptly identifying and intervening in cognitive decline and frailty status in older individuals without delay.

Cognitive deficits profiles in the first-episode of schizophrenia, clinical high risk of psychosis, and genetically high-risk of psychosis.

Cognitive deficits are core characteristics of schizophrenia, presenting before the emergence of psychotic symptoms. Individuals with a clinical high-risk for psychosis (CHR) and those with genetically high-risk of psychosis (GHR) also exhibit cognitive impairments. Nonetheless, it remains uncertain in which domains of cognitive impairments in these two groups were more similar to those of schizophrenia patients. Moreover, it is unclear which domains of impairment are caused by quality factors and which are more related to the state of disease. This research initiative aimed to extensively examine the distinct cognitive impairment profiles among the CHR, GHR, and first-episode schizophrenia (FES) cohorts. We compared the cognitive functions of the three groups and a healthy control group (HCs) using the MATRICS Consensus Cognitive Battery (MCCB). The participants for this study were recruited from the Beijing Anding Hospital of Capital Medical University. Our sample consisted of 56 patients with FES, 42 with CHR, 26 with GHR, and 62 HCs. The participants across all groups were matched in terms of gender, age, and level of education. Individuals with FES, GHR, and CHR showed significant impairment across the majority of MCCB domains, with the exception of visual learning, in comparison to HCs. None of the MCCB domains demonstrated a discerning ability to accurately differentiate between individuals with CHR and those with GHR. In the speed of processing and attention/vigilance domains, individuals with GHR and CHR exhibited scores between those of FES and HCs, with all group differences reaching statistical significance. This pattern of results indicates an intermediate level of cognitive function in individuals with GHR and CHR. Conversely, the levels of impairment observed in working memory and verbal learning were relatively consistent across all three groups: FES, CHR, and GHR. Notably, individuals in the CHR group exhibited performance akin to that of the HCs in the reasoning/problem-solving domain, while showing significant differences from the FES group, with the CHR individuals demonstrating better performance. Additionally, individuals with GHR displayed performance in social cognition similar to that of the HCs, while also demonstrating significant distinctions from the FES group, with the GHR individuals demonstrating better performance. Significant cognitive deficits exist in individuals with CHR, GHR, and FES, and these deficits vary across domains. Processing speed and attention/vigilance could potentially serve as robust biomarkers for identifying individuals at a risk of psychosis. The impairment observed in reasoning/problem-solving abilities might signify a qualitative trait, whereas deficits in social recognition could indicate a state characteristic specific to schizophrenia.

Exploring language performance in people with mild cognitive impairment and Alzheimer's disease: a prospective longitudinal study

Background/Aims Language changes are the earliest signs and symptoms of mild cognitive impairment and Alzheimer's disease. The aim of this study was to explore the language difference performance between people with mild cognitive impairment, people with Alzheimer's disease and healthy individuals as a control group. To accomplish this aim, the language profile of both mild cognitive impairment and Alzheimer's disease needs to be characterised to determine which feature is more affected by both mild cognitive impairment and Alzheimer's disease among expressive language, receptive language, executive function and memory performance. Methods This case-control prospective study involved 90 participants. The Mini-Mental Status Examination and the Functional Assessment Staging Tool were used to classify the participants into three groups: people with mild cognitive impairment, people with Alzheimer's disease and healthy individuals as a control group. Then, the language performance of patients in the mild cognitive impairment and Alzheimer's disease groups was investigated and compared with those of the control group by using the Barnes Language Assessment. The groups were reassessed 6 months later to see if there was any change in language ability. Results The results showed that the mild cognitive impairment group and Alzheimer's disease group had significant decreases in expressive language (P&gt;0.01), executive function (P&gt;0.01), receptive language (P&gt;0.01) and memory skills (P&gt;0.01) from baseline to the reassessment at 6 months. Conclusions Language deficits, especially expressive language deficits, could appear before impairment in executive function, receptive language and verbal episodic memory in participants with mild cognitive impairment or Alzheimer's disease. Speech and language therapists can use the findings of this study to design and implement treatment programmes.

Dementia is an auditory brain disorder

AbstractBackgroundWhile impaired hearing has emerged as a major potentiating factor for dementia, the basis for this relationship has not been defined. Most studies have emphasised the role of peripheral hearing loss. However, we hear with our brains: natural listening places immense computational demands on neural circuitry, and the neural networks pre‐eminently targeted by major dementias are essential for decoding and responding appropriately to the auditory environment. Auditory brain dysfunction is therefore predicted both to contribute importantly to hearing impairment in Alzheimer’s and other dementias and to be integral to the expression of neurodegenerative pathologies. Here I present an overview of evidence that speaks to this hypothesis.MethodsIn a series of linked experiments, we have assessed aspects of auditory cognition – the processes whereby the brain perceives, interprets and acts upon sounds ‐ in patient cohorts with Alzheimer’s disease and major syndromes of frontotemporal dementia, relative to healthy older individuals. We designed novel psychoacoustic tests to assess aspects of auditory scene analysis (the ‘cocktail party effect’ and localisation of sounds in space), comprehension of acoustically degraded speech and the processing of semantic and emotional information in sound in cognitively impaired people. Neuroanatomical mechanisms were assessed using voxel‐based morphometry and functional MRI.ResultsAcross experiments, after taking peripheral hearing function and general cognitive performance into account, patients with Alzheimer’s disease and frontotemporal dementias showed characteristic ‘auditory phenotypes’ or profiles of auditory cognitive impairment. Alzheimer’s disease is associated with impaired auditory scene analysis, linked to atrophy and dysfunction of temporo‐parietal cortical regions in the core ‘default mode network’ targeted by Alzheimer pathology. Frontotemporal dementia syndromes produce distinct impairments of auditory feature analysis, sound recognition and emotional valuation.ConclusionsAuditory brain dysfunction plays a key role in everyday hearing impairment and reflects core pathophysiology in major dementias. These findings raise the exciting prospect that auditory cognitive measures might be used in the early diagnosis of dementia, in guiding novel hearing interventions and as dynamic markers of therapeutic response in the dawning era of disease modification.

Age determines the profile of cognitive impairment after COVID‐19. Results of an international, multi‐cohort, pooled analysis and meta‐analysis

AbstractBackgroundEvidence‐based data are still lacking to define de characteristics of cognitive impairment after COVI‐19. Previous findings suggest that Covid‐19 sequelae may resemble early Alzheimer’s disease (AD). In this abstract, our team present data from Argentina, Canada, Russia, Greece, and the UK including 1919 patients and 1031 controls.MethodParticipants were 18 to 97 years old. Neuropsychological evaluation included Montreal Cognitive Assessment – MoCA, Toronto Cognitive Assessment‐ TORCA, and/or batteries specially built for the evaluation of cognitive dimensions. Some cohorts included the anosmia. Participants were evaluated at a maximum of 6 months after discharge. A factorial analysis was performed on each country identifying 3 factors that could be compared between countries: one accounting for memory and language, the second is an attentional factor, and the last is a working memory factor. Between countries that have young population, there was a fourth factor accounting for executive functioning (planning and inhibition). We carried out meta‐analysis of common factors and co‐variates.ResultAverage duration of formal learning is 11.06 ± 5.11 years, and the mean age is 52.61 ± 15.87 years. Meta‐analysis revealed an impairment in language (verbal fluency) for all patients vs controls. Factorial scores revealed that all the participants were impaired in attentional tasks but those over 60 years old were impaired also in working memory and the youngest participants in executive functioning. Significant differences between cases and controls in attentional, memory, and language tasks identified 4 different groups: normal cognition (71%); one dimension impaired (20.5%); two dimensions impaired (6.5%); and three dimensions impaired (2%). In older adults, these proportions rise to 28% for the impairment in one dimension; 11.5% for two dimensions, and 3.5% for three dimensions and is significantly associated with the infection diagnoses (p = 0.013) and with presence and severity of anosmia (p = 0,000).ConclusionOlder adults are at greater risk of suffering persistent cognitive impairment after recovery from SARS‐CoV‐2 infection and cognitive impairment is correlated with the presence and severity of anosmia.

Using data‐driven approaches to reveal distinct neurocognitive profiles in posterior cortical atrophy

AbstractBackgroundPosterior cortical atrophy (PCA) is a clinically defined syndrome characterized by impairment in higher‐order visual processing due to neurodegeneration of posterior brain regions (occipito‐parietal and occipito‐temporal areas). Previous findings have reported broader cognitive impairment profiles, but their association with neural correlates remains unclear. In this project we aimed to use principal component analysis to explore the relationship between various cognitive dimensions and FDG‐PET hypometabolism in PCA patients.MethodWe included 59 patients with a clinical diagnosis of PCA (with supporting radiological evidence) from the Memory and Aging Center database at the University of California in San Francisco (Table 1). The sample consisted of 64.4% females, mean age was 63.0 ± 7.6, and mean MMSE was 20.7 ± 5.6 at the diagnostic visit. Participants underwent extensive neuropsychological assessment; these scores were subsequently entered into an orthogonally‐rotated principal component analysis. In a subset of patients with FDG‐PET (N = 24), associations between the emergent cognitive components and whole‐brain hypometabolism were examined to explore neural correlates of cognitive heterogeneity.ResultFive components explained 72% of overall performance variation in PCA patients: episodic memory, visuospatial function, working memory, verbal generation, and naming/depression (Figure 1). Labels were assigned base on the primary area of greatest cognitive dysfunction. Visualization of component scores suggested systematic performance variation within the PCA sample. The mean metabolism map showed, as expected, predominant hypometabolism in occipito‐parietal and occipito‐temporal regions (Figure 2A). Voxel‐wise correlations revealed that hypometabolism in distinct frontoparietal regions underpinned episodic memory and visuospatial (inferior/superior parietal lobes), working memory and verbal generation (superior/middle frontal gyrus) performance (Figure 2B).ConclusionPCA is a cognitively heterogeneous syndrome, where patients can show varying levels of cognitive deficits across episodic and working memory, executive functions, language and affect, over and above canonical visuospatial impairments.

Adverse Childhood Experiences and Higher Levels of Stress Are Associated With the Co-occurrence of Cancer-Related Cognitive Impairment and Anxiety

We sought to identify subgroups of patients with distinct joint cancer-related cognitive impairment (CRCI) AND anxiety profiles and evaluate for differences in demographic and clinical characteristics, as well as levels of global stress, cancer-specific stress, cumulative life stress, and resilience. Patients (n = 1332) completed the Attentional Function Index and the Spielberger State Anxiety Inventory six times over two cycles of chemotherapy. Global, cancer-specific, and cumulative life stress and resilience were evaluated using Perceived Stress Scale, Impact of Event Scale-Revised, Life Stressor Checklist-Revised, and Connor-Davidson Resilience Scale, respectively. Latent profile analysis was used to identify subgroups of patients with distinct joint CRCI AND anxiety profiles. Differences were evaluated using parametric and nonparametric tests. Three classes were identified (ie, No CRCI and Low Anxiety [57.3%], Moderate CRCI and Moderate Anxiety [34.5%], and High CRCI and High Anxiety [8.2%]). All of the stress measures showed a dose-response effect (ie, as the CRCI AND anxiety profile worsened, scores for all three types of stress increased). The two highest symptom classes reported higher occurrence rates for six specific stressors (eg, emotional abuse, physical abuse, sexual harassment). Findings suggest that higher levels of co-occurring CRCI AND anxiety are associated with some common risk factors, as well as higher levels of stress and lower levels of resilience. Increased knowledge of modifiable risk factors and sources of stress associated with the co-occurrence of these two symptoms will assist clinicians to identify high-risk patients and implement individualized interventions.

A comparative study of posterior cingulate metabolism in patients with mild cognitive impairment due to Parkinson's disease or Alzheimer's disease

Few comparative studies have assessed metabolic brain changes in cognitive impairment among neurodegenerative disorders, and the posterior cingulate cortex (PCC) is a metabolically active brain region with high involvement in multiple cognitive processes. Therefore, in this study, metabolic abnormalities of the PCC were compared in patients with mild cognitive impairment (MCI) due to Parkinson’s disease (PD) or Alzheimer’s disease (AD), as examined by proton magnetic resonance spectroscopy (1H-MRS). Thirty-eight patients with idiopathic PD, including 20 with mild cognitive impairment (PDMCI) and 18 with normal cognitive function (PDN), 18 patients with probable mild cognitive impairment (ADMCI), and 25 healthy elderly controls (HCs) were recruited and underwent PCC 1H-MRS scans. Compared with HCs, patients with PDMCI exhibited significantly reduced concentrations of N-acetyl aspartate (NAA), total NAA (tNAA), choline (Cho), glutathione (GSH), glutamate + glutamine (Glx) and total creatine (tCr), while ADMCI cases exhibited significantly elevated levels of myo-inositol (Ins) and Ins/tCr ratio, as well as reduced NAA/Ins ratio. No significant metabolic changes were detected in PDN subjects. Compared with ADMCI, reduced NAA, Ins and tCr concentrations were detected in PDMCI. Besides, ROC curve analysis revealed that tCr concentration could differentiate PDMCI from PDN with an AUC of 0.71, and NAA/Ins ratio could differentiate patients with MCI from controls with normal cognitive function with an AUC of 0.74. Patients with PDMCI and ADMCI exhibited distinct PCC metabolic 1H-MRS profiles. The findings suggested cognitively normal PD patients with low NAA and tCr in the PCC might be at risk of preclinical PDMCI, and Ins and/or NAA/MI ratio in the PCC should be reconsidered a possible biomarker of preclinical MCI in clinical practice. So, comparing PCC’s 1H-MRS profiles of cognitive impairment among neurodegenerative illnesses may provide useful information for better defining the disease process and elucidate possible treatment mechanisms.

Basal ganglia ischaemic infarction after thrombectomy: cognitive impairment at acute stage.

After successful mechanical thrombectomy for middle cerebral artery occlusion, basal ganglia infarction is commonly detectable. Whilst the functional outcome of these patients is often good, less knowledge is available about the cognitive outcome. The aim of our study was to assess the presence of cognitive impairment within 1 week after thrombectomy. In all, 43 subjects underwent a general cognitive assessment using the Montreal Cognitive Assessment and an extensive battery of tests. Patients were classified as cognitively impaired (CImp) or not (noCImp) according to a Montreal Cognitive Assessment score below 18. Cognitively impaired and noCImp subjects did not differ either in their National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at admittance, or in their Fazekas score and Alberta Stroke Program Early Computed Tomography Score. At discharge, CImp subjects showed higher scores than noCImp subjects on NIHSS (p = 0.002) and mRS (p < 0.001). The percentage of pathological performances on each neuropsychological test in the whole sample and in CImp and noCImp patients shows a similar cognitive profile between the groups. Some patients who underwent thrombectomy experienced a detectable cognitive impairment that probably led to worse NIHSS and mRS. The neuropsychological profile of such cognitive impairment at the acute stage consists of wide deficits in numerous cognitive domains, suggesting that basal ganglia damage may lead to complex functional impairments.

Cognitive impairment in people living with HIV: consensus recommendations for a new approach.

Current approaches to classifying cognitive impairment in people living with HIV can overestimate disease burden and lead to ambiguity around disease mechanisms. The 2007 criteria for HIV-associated neurocognitive disorders (HAND), sometimes called the Frascati criteria, can falsely classify over 20% of cognitively healthy individuals as having cognitive impairment. Minimum criteria for HAND are met on the basis of performance on cognitive tests alone, which might not be appropriate for populations with diverse educational and socioeconomic backgrounds. Imprecise phenotyping of cognitive impairment can limit mechanistic research, biomarker discovery and treatment trials. Importantly, overestimation of cognitive impairment carries the risk of creating fear among people living with HIV and worsening stigma and discrimination towards these individuals. To address this issue, we established the International HIV-Cognition Working Group, which is globally representative and involves the community of people living with HIV. We reached consensus on six recommendations towards a new approach for diagnosis and classification of cognitive impairment in people living with HIV, intended to focus discussion and debate going forward. We propose the conceptual separation of HIV-associated brain injury - including active or pretreatment legacy damage - from other causes of brain injury occurring in people living with HIV. We suggest moving away from a quantitative neuropsychological approach towards an emphasis on clinical context. Our recommendations are intended to better represent the changing profile of cognitive impairment in people living with HIV in diverse global settings and toprovide a clearer framework of classification for clinical management and research studies.

Global assessment, cognitive profile, and characteristics of mild cognitive impairment in Parkinson's disease.

Cognitive deficits are evident throughout the course of Parkinson's disease (PD), with 24% of patients experiencing subtle cognitive disturbances at the time of diagnosis, and with up to 80% of patients developing PD dementia (PDD) at advanced stages of the disease PD patients with mild cognitive impairment (MCI), an at-risk phenotype of PDD, present with heterogeneous clinical characteristics that complicate the management of PD. This study aims to examine the characteristics of PD-MCI by using the Movement Disorder Society (MDS) diagnostic criteria and evaluate the validity of global cognitive scales in identifying PD-MCI. Seventy-nine (79) PD patients completed neuropsychological assessments and a comprehensive cognitive battery. PD-MCI was classified according to the level 2 MDS task force criteria. Mini-Mental State Examination (sMMSE), Montreal Cognitive Assessment (MoCA) and Parkinson's Disease Cognitive Rating Scale (PDCRS) were examined against a level 2 dichotomised PD-MCI diagnosis. Characteristics of PD-MCI were evaluated using logistic regression analysis. Twenty-seven patients met criteria for PD-MCI (34%). The MoCA and PDCRS demonstrated high validity to screen for PD-MCI. Impairments in multiple cognitive domains were observed in 77.8% of PD-MCI patients. There were significantly more males in the PD-MCI group compared to PD patients without MCI (p<0.01). PD patients with MCI exhibited impairments in the attention/working memory, executive function and memory domains. Heterogeneous cognitive characteristics in PD warrant further investigation into specific cognitive subtypes to advance understanding and effective evaluation of PD-MCI.

Intranasal administration of collagenase develops cerebral microbleeds and vascular dementia in mice: In vivo pilot study

ObjectiveTo establish a new animal model of lobar cerebral microbleeds (CMBs), we examined whether intranasal administration of collagenase induced CMBs in young mice which did not have hypertensive pathologic features. MethodsWe used thirty-two male CD1 mice (8–10 weeks old), which were received either phosphate-buffered saline (PBS) or collagenase by intranasal administration twice a day for 5 days. A dose response study was conducted, and motor function and number of CMBs was evaluated at one day after completing the intranasal administration. Temporal profile of cognitive impairment and number of CMBs through 7 days was evaluated after completing intranasal administration of 3.6U collagenase. ResultsThe number of CMBs showed an increasing trend in a dose-dependent manner and higher number of CMBs were observed with 3.6U collagenase. Cognitive impairment and CMBs was observed in 3.6U collagenase groups up to 7 days after administration. In addition, successful brain delivery via intranasal route was comfirmed by administering fluorescein isothiocyanate-labeled bovine serum albumin. ConclusionsIntranasal collagenase administration is a feasible and minimally invasive method to produce CMBs and cognitive impairment in mice. This model has potential for producing CMBs in animals with cerebral amyloid angiopathy such as transgenic mice models of Alzheimer’s disease.