Cognitive Impairment Syndrome Research Articles

Use of MRI to identify preclinical vascular dementia in symptomatic small vessel disease

BackgroundSporadic cerebral small vessel disease is an important cause of vascular dementia, and is a syndrome of cognitive impairment with evidence of vascular brain damage. At post-mortem examination pure vascular dementia is rare, with coexisting Alzheimer's disease pathology in 95% of cases. We aimed to use MRI to characterise the structural abnormalities during the preclinical phase of vascular dementia in symptomatic small vessel disease, and use these characteristics to accurately predict the development of future dementia. Methods121 adults with symptomatic small vessel disease were initially recruited to the St George's Cognition and Neuroimaging in Stroke (SCANS) study and followed up longitudinally for 5 years, with 22 individuals converting to dementia. Baseline T1-weighted MRI data were acquired for all 121 partcipants. Voxel-based morphometry was used to identify differences in patients with preclinical vascular dementia. Support vector machines were then used to predict future dementia from the baseline scans. Anatomical endophenotypes were defined using cluster ward linkage. FindingsWe found reduced grey matter density in the left striatum and hippocampus, and more white matter hyperintensities in the frontal white matter, in preclinical dementia. Future dementia could be predicted with a balanced accuracy of 73%. Four anatomical subtypes were identified. In one of them, patients were younger than those in the other three groups and had the highest levels of vascular damage; they also had milder cognitive impairment but rapid deterioration in processing speed and executive function, consistent with primary vascular dementia. The other groups had progressively less vascular damage and increasing memory impairment consistent with more Alzheimer's like pathology. The rates of hippocampal atrophy supported these groupings, with the vascular group resembling the cohort that did not develop dementia, and the Alzheimer's like group demonstrating more global hippocampal atrophy. InterpretationWe show that baseline MRI can reliably predict preclinical vascular dementia, with 73% of patients converting to dementia within 5 years. MRI can identify distinct anatomical endophenotypes representing a spectrum between vascular and Alzheimer's like pathology. This work provides a way to accurately stratify patients by use of a baseline MRI scan, and has utility in future clinical trials designed to slow or prevent the onset of dementia in these high-risk cohorts. FundingThe SCANS study was supported by the Wellcome Trust (grant 081589). Patient recruitment was supported by the National Institute for Health Research (NIHR) Clinical Stroke Research Network.

Cognitive impairment and Charles Bonnet syndrome: a prospective study.

Charles Bonnet syndrome (CBS) is a common cause of visual hallucinations in older people. The relationship between CBS and cognitive impairment is unclear, but anecdotal reports exist of dementia emerging in patients diagnosed with CBS. This work set out to determine if there is an increased incidence of dementia, and increased severity of cognitive impairment, in people with CBS compared to controls from the same clinical setting. People over 65 attending low-vision and glaucoma clinics, and a cohort of age-matched controls, underwent a psychiatric assessment. The cohorts were followed up after one year. Mild cognitive impairment was present in 2/12 CBS participants and 2/10 controls. Partial insight was seen in nine CBS participants. Two participants with CBS, and no controls, developed dementia at follow-up. No significant differences in performance on the ACE-R were found between the groups. Both participants who developed dementia had partial insight and hallucinations of familiar figures at diagnosis of CBS, and one had mild cognitive impairment. Reassurance that CBS is universally benign may be misplaced. Some people given this diagnosis go on to develop dementia. Cognitive testing at the point of diagnosis was unable to identify those at risk of this outcome. Partial insight, the presence of Mild Cognitive Impairment, and hallucinations of familiar figures at diagnosis of CBS may confer an increased risk of subsequent dementia diagnosis. Copyright © 2017 John Wiley & Sons, Ltd.

Cognitive dysfunction and general anesthesia: From pathogenesis to prevention and correction

Postoperative cognitive dysfunction (POCD) is a cognitive impairment syndrome of multifactorial etiology after general anesthesia and surgery. The urgency of the problem associated with the prevention and correction of POCD is due to its high frequency particularly in elderly patients and to the long-term sequels that impair quality of life. To date, the possibilities of preventing POC remain controversial; there is no generally accepted effective strategy for reducing its incidence. A number of proposed techniques aimed at reducing the risk of cognitive impairments lead, among other things, to improvements in surgical and anesthetic techniques with transition to minimally invasive interventions and to the use of short-acting general anesthetics. However, by taking into account the multifactorial genesis of POCD and the involvement of mechanisms, such as neuroinflammation and apoptosis, in its development, the additional use of neuroprotective agents seems justified. Further investigations are needed to develop effective therapeutic strategies for treating POCD. This review gives the data currently available in the literature on the clinical phenomenology, pathogenesis, treatment, and pharmacological prevention of POCD.

Montefiore-Einstein Center for the Aging Brain: Preliminary Data.

Given the multifaceted nature of dementia care management, an interdisciplinary comprehensive clinical approach is necessary. We describe our one-year experience with outpatient based dementia care at the Montefiore-Einstein Center for the Aging Brain (CAB) involving an multispecialty team of geriatricians, neurologists, and neuropsychologists, supported by geriatric psychiatrists, physiatrists, and social services. The goals of the CAB is to maximize dementia outcomes, including regular monitoring of patient's health and cognition, education and support to patients, their families and caregivers; initiation of pharmacological and non-pharmacological treatments as appropriate, and the facilitation of access to clinical trials. The CAB follows a consultative model where patients referred to the center receive a comprehensive three step evaluation and management plan from Geriatric, Neuropsychology and Neurology specialists that is shared with patient, caregivers and primary care physicians. Of the 366 patients seen for cognitive complaints in our first year, 71% were women with a mean age of 74 years. Self-identified ethnicity of patients included Caucasian (26%), African-American (25%), Hispanic (18%) and multiracial (5%). Common final diagnoses assigned at the CAB included mild cognitive impairment syndromes (31%), Alzheimer's disease (20%), mixed dementia (11%), vascular dementia (9%), Frontotemporal dementia (4%) and dementia with Lewy bodies (4%). Our one-year progress report indicates that an interdisciplinary clinical dementia care model is feasible in the outpatient setting as well as highly accepted by patients, caregivers and referring physicians.

Chemotherapy-Related Neurotoxicity.

Chemotherapy may have detrimental effects on either the central or peripheral nervous system. Central nervous system neurotoxicity resulting from chemotherapy manifests as a wide range of clinical syndromes including acute, subacute, and chronic encephalopathies, posterior reversible encephalopathy, acute cerebellar dysfunction, chronic cognitive impairment, myelopathy, meningitis, and neurovascular syndromes. These clinical entities vary by causative agent, degree of severity, evolution, and timing of occurrence. In the peripheral nervous system, chemotherapy-induced peripheral neuropathy (CIPN) and myopathy are the two main complications of chemotherapy. CIPN is the most common complication, and the majority manifest as a dose-dependent length-dependent sensory axonopathy. In severe cases of CIPN, the dose of chemotherapy is reduced, the administration delayed, or the treatment discontinued. Few treatments are available for CIPN and based on meta-analysis, duloxetine is the preferred symptomatic treatment. Myopathy due to corticosteroid use is the most frequent cause of muscle disorders in patients with cancer.

The Cognition and Affect after Stroke - a Prospective Evaluation of Risks (CASPER) study: rationale and design.

BackgroundCognitive impairment and neuropsychiatric syndromes, like depression and apathy, are frequent residual consequences of stroke. These have a large impact on quality of life and long-term prognosis. Several factors are involved in the development of these residual syndromes, although their exact role and their interrelationships remain still rather unclear. The Cognition and Affect after Stroke: a Prospective Evaluation of Risks (CASPER) study has been primarily designed to examine whether stroke-specific (e.g. lesion location, volume, type, severity), cerebrovascular and neurodegenerative (e.g. white matter changes, atrophy, microbleeds, perivascular spaces), inflammatory, endothelial, and (epi)genetic markers are associated with cognitive impairment, post-stroke depression, and post-stroke apathy, and whether they predict their course over 12 months. The secondary aims are to investigate how the above-mentioned markers interact with each other, and to determine if patients with apathy and depression after stroke differ in pathogenesis, course, and outcome (e.g. functional outcome, neurocognitive performance, quality of life).Methods/designCASPER is a 1-year prospective clinical cohort follow-up study in 250 stroke patients recruited at the neurological in- and outpatient services at Maastricht University Medical Center (MUMC+, Maastricht, The Netherlands), and Zuyderland Medical Center (Sittard and Heerlen, The Netherlands). At baseline (3 months post-stroke), a neuropsychological assessment, neuropsychiatric interview, blood sample, and brain magnetic resonance imaging (MRI) scan are conducted. Assessment of neuropsychiatric and neurocognitive status are repeated 6 and 12 months later.DiscussionThe CASPER study investigates stroke-specific, vascular, neurodegenerative, inflammatory, and genetic markers of the development of vascular cognitive impairment, depression, and apathy after stroke. This creates the possibility to study not only the contribution of these individual markers but also their joint contribution, which differentiates this study from earlier stroke cohorts who lacked long-term follow-up data, a large sample size, an extensive MRI protocol, and markers from the blood. The knowledge we derive from this study might help in identifying markers that are associated with, or can predict the onset, maintenance, and progression of vascular cognitive impairment, depression, and apathy after stroke, and could provide new insights into possibilities for treatment and rehabilitation that result in better functional outcome after stroke.Trial registrationClinicalTrials.gov NCT02585349

Minimal cerebral dysfunctions and ADHD in adulthood

Attention deficit hyperactivity disorder (ADHD) is of great importance not only in children but also in adults; however, despite extensive research there are still many unsolved questions with respect to the diagnosis. Patients not only suffer from attention deficits and hyperactivity but also a variety of other problems, such as dyspraxia, problems with stimulus discrimination, dysgrammatism, legasthenia, or motor coordination problems. Furthermore, there are also psychopathological disorders, such as problems with memory, formal thinking, emotional modulation, drive and vegetative stability, in the sense of a psycho-organic syndrome. Such syndromes have long been known in psychiatry under terms, such as complex capacity disorders, minimal cerebral dysfunction (MCD), minimal brain dysfunction (MBD), mild psycho-organic syndrome, psycho-organic axis syndrome, mild cognitive impairment, developmental disorder and developmental biological syndrome. Etiological data with respect to genetics and early childhood brain trauma support the notion of a psychobiological disorder for complex cerebral dysfunction in the sense of a psycho-organic syndrome. Depending on the individual life and work situation, these additional symptoms of ADHD are in many cases of greater relevance for life adjustment than the core symptoms, depending on the individual life and work situations. The concept of minimal cerebral dysfunction describes the ADHD problem better and has a direct bearing on the diagnosis, therapy and sociomedical care of the patients.

White matter hyperintensities and geriatric syndrome: An important role of arterial stiffness.

White matter hyperintensities (WMH) are defined as cerebral white matter changes presumed to be of vascular origin, bilateral and mostly symmetrical. They can appear as hyperintense on T2-weighted and fluid-attenuated inversion recovery sequences, and as isointense or hypointense on T1-weighted magnetic resonance imaging of the brain. WMH have been focused on because of their clinical importance as a risk factor for cerebrovascular diseases and cognitive impairment. WMH are associated with geriatric syndrome, which is defined by clinical symptoms characteristic of older adults, including cognitive and functional impairment and falls. Cerebral small vessel diseases, such as WMH, might play an important role as risk factors for cerebrovascular diseases, cognitive impairment and geriatric syndrome through the mechanism of arterial stiffness. However, the vascular, physiological and metabolic roles of arterial stiffness remain unclear. Basically, arterial stiffness indicates microvessel arteriosclerosis presenting with vascular endothelial dysfunction. These changes might arise from hemodynamic stress as a result of a "tsunami effect" on cerebral parenchyma. In the present article, we review the clinical characteristics of WMH, focusing particularly on two associations: (i) those between cerebral small vessel diseases including WMH and arterial stiffness; and (ii) those between WMH and geriatric syndrome.

Montreal Cognitive Assessment for the diagnosis of Alzheimer's disease and other dementias.

Dementia is a progressive syndrome of global cognitive impairment with significant health and social care costs. Global prevalence is projected to increase, particularly in resource-limited settings. Recent policy changes in Western countries to increase detection mandates a careful examination of the diagnostic accuracy of neuropsychological tests for dementia. To determine the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) at various thresholds for dementia and its subtypes. We searched MEDLINE, EMBASE, BIOSIS Previews, Science Citation Index, PsycINFO and LILACS databases to August 2012. In addition, we searched specialised sources containing diagnostic studies and reviews, including MEDION (Meta-analyses van Diagnostisch Onderzoek), DARE (Database of Abstracts of Reviews of Effects), HTA (Health Technology Assessment Database), ARIF (Aggressive Research Intelligence Facility) and C-EBLM (International Federation of Clinical Chemistry and Laboratory Medicine Committee for Evidence-based Laboratory Medicine) databases. We also searched ALOIS (Cochrane Dementia and Cognitive Improvement Group specialized register of diagnostic and intervention studies). We identified further relevant studies from the PubMed 'related articles' feature and by tracking key studies in Science Citation Index and Scopus. We also searched for relevant grey literature from the Web of Science Core Collection, including Science Citation Index and Conference Proceedings Citation Index (Thomson Reuters Web of Science), PhD theses and contacted researchers with potential relevant data. Cross-sectional designs where all participants were recruited from the same sample were sought; case-control studies were excluded due to high chance of bias. We searched for studies from memory clinics, hospital clinics, primary care and community populations. We excluded studies of early onset dementia, dementia from a secondary cause, or studies where participants were selected on the basis of a specific disease type such as Parkinson's disease or specific settings such as nursing homes. We extracted dementia study prevalence and dichotomised test positive/test negative results with thresholds used to diagnose dementia. This allowed calculation of sensitivity and specificity if not already reported in the study. Study authors were contacted where there was insufficient information to complete the 2x2 tables. We performed quality assessment according to the QUADAS-2 criteria.Methodological variation in selected studies precluded quantitative meta-analysis, therefore results from individual studies were presented with a narrative synthesis. Seven studies were selected: three in memory clinics, two in hospital clinics, none in primary care and two in population-derived samples. There were 9422 participants in total, but most of studies recruited only small samples, with only one having more than 350 participants. The prevalence of dementia was 22% to 54% in the clinic-based studies, and 5% to 10% in population samples. In the four studies that used the recommended threshold score of 26 or over indicating normal cognition, the MoCA had high sensitivity of 0.94 or more but low specificity of 0.60 or less. The overall quality and quantity of information is insufficient to make recommendations on the clinical utility of MoCA for detecting dementia in different settings. Further studies that do not recruit participants based on diagnoses already present (case-control design) but apply diagnostic tests and reference standards prospectively are required. Methodological clarity could be improved in subsequent DTA studies of MoCA by reporting findings using recommended guidelines (e.g. STARDdem). Thresholds lower than 26 are likely to be more useful for optimal diagnostic accuracy of MoCA in dementia, but this requires confirmation in further studies.

Mutation spectra of histone methyltransferases with canonical SET domains and EZH2-targeted therapy.

Germline mutations in canonical SET-methyltransferases have been identified in autism and intellectual disability syndromes and gain-of-function somatic alterations in EZH2, MLL3, NSD1, WHSC1 (NSD2) and WHSC1L1 (NSD3) in cancer. EZH2 interacts with AR, ERα, β-catenin, FOXP3, NF-κB, PRC2, REST and SNAI2, resulting in context-dependent transcriptional activation and repression. Pharmacological EZH2 inhibitors are currently in clinical trials for the treatment of B-cell lymphomas and solid tumors. EZH2 inhibitors might also be applicable in the treatment of SWI/SNF-mutant cancers, reflecting the reciprocal expression of and functional overlap between EZH2 and SMARCA4. Because of the risks for autoimmune diseases, cognitive impairment, cardiomyopathy and myelodysplastic syndrome, EZH2 inhibitors should be utilized for cancer treatment in patients receiving long-term surveillance but not for cancer chemoprevention.

Tau hyperphosphorylation in synaptosomes and neuroinflammation are associated with canine cognitive impairment.

Canine cognitive impairment syndrome (CDS) represents a group of symptoms related to the aging of the canine brain. These changes ultimately lead to a decline of memory function and learning abilities, alteration of social interaction, impairment of normal housetraining, and changes in sleep-wake cycle and general activity. We have clinically examined 215 dogs, 28 of which underwent autopsy. With canine brains, we performed extensive analysis of pathological abnormalities characteristic of human Alzheimer's disease and frontotemporal lobar degeneration, including β-amyloid senile plaques, tau neurofibrillary tangles, and fused in sarcoma (FUS) and TAR DNA-binding protein 43 (TDP43) inclusions. Most demented dogs displayed senile plaques, mainly in the frontal and temporal cortex. Tau neurofibrillary inclusions were found in only one dog. They were identified with antibodies used to detect tau neurofibrillary lesions in the human brain. The inclusions were also positive for Gallyas silver staining. As in humans, they were distributed mainly in the entorhinal cortex, hippocampus, and temporal cortex. On the other hand, FUS and TDP43 aggregates were not present in any of the examined brain samples. We also found that CDS was characterized by the presence of reactive and senescent microglial cells in the frontal cortex. Our transcriptomic study revealed a significant dysregulation of genes involved in neuroinflammation. Finally, we analyzed tau phosphoproteome in the synaptosomes. Proteomic studies revealed a significant increase of hyperphosphorylated tau in synaptosomes of demented dogs compared with nondemented dogs. This study suggests that cognitive decline in dogs is related to the tau synaptic impairment and neuroinflammation. J. Comp. Neurol. 524:874-895, 2016. © 2015 Wiley Periodicals, Inc.

Помірні когнітивні розлади у хворих з артеріальною гіпертензією

У роботі розглянута ефективність використання холіну альфосцерату (Гліатилін) у хворих з артеріальною гіпертензією та синдромом помірних когнітивних розладів. Дослідження проводилося протягом двох місяців. До групи спостереження увійшли 28 осіб віком від 50 до 70 років з діагнозом гіпертонічної хвороби II стадії, 2-го ступеня, високого ризику. Пацієнтам проводили неврологічні, нейропсихологічні, лабораторні та інструментальні дослідження. Результати роботи довели, що стабілізація артеріального тиску в поєднанні з терапією Гліатиліном позитивно вплинула на загальний стан пацієнтів, покращила їх когнітивні функції, стабілізувала психоемоційний стан.

Mini-Mental State Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI).

Dementia is a progressive global cognitive impairment syndrome. In 2010, more than 35 million people worldwide were estimated to be living with dementia. Some people with mild cognitive impairment (MCI) will progress to dementia but others remain stable or recover full function. There is great interest in finding good predictors of dementia in people with MCI. The Mini-Mental State Examination (MMSE) is the best-known and the most often used short screening tool for providing an overall measure of cognitive impairment in clinical, research and community settings. To determine the diagnostic accuracy of the MMSE at various thresholds for detecting individuals with baseline MCI who would clinically convert to dementia in general, Alzheimer's disease dementia or other forms of dementia at follow-up. We searched ALOIS (Cochrane Dementia and Cognitive Improvement Specialized Register of diagnostic and intervention studies (inception to May 2014); MEDLINE (OvidSP) (1946 to May 2014); EMBASE (OvidSP) (1980 to May 2014); BIOSIS (Web of Science) (inception to May 2014); Web of Science Core Collection, including the Conference Proceedings Citation Index (ISI Web of Science) (inception to May 2014); PsycINFO (OvidSP) (inception to May 2014), and LILACS (BIREME) (1982 to May 2014). We also searched specialized sources of diagnostic test accuracy studies and reviews, most recently in May 2014: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). No language or date restrictions were applied to the electronic searches and methodological filters were not used as a method to restrict the search overall so as to maximize sensitivity. We also checked reference lists of relevant studies and reviews, tracked citations in Scopus and Science Citation Index, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on MMSE for dementia diagnosis to try to locate possibly relevant but unpublished data. We considered longitudinal studies in which results of the MMSE administered to MCI participants at baseline were obtained and the reference standard was obtained by follow-up over time. We included participants recruited and clinically classified as individuals with MCI under Petersen and revised Petersen criteria, Matthews criteria, or a Clinical Dementia Rating = 0.5. We used acceptable and commonly used reference standards for dementia in general, Alzheimer's dementia, Lewy body dementia, vascular dementia and frontotemporal dementia. We screened all titles generated by the electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility and extracted data to create two by two tables for dementia in general and other dementias. Two authors independently performed quality assessment using the QUADAS-2 tool. Due to high heterogeneity and scarcity of data, we derived estimates of sensitivity at fixed values of specificity from the model we fitted to produce the summary receiver operating characteristic curve. In this review, we included 11 heterogeneous studies with a total number of 1569 MCI patients followed for conversion to dementia. Four studies assessed the role of baseline scores of the MMSE in conversion from MCI to all-cause dementia and eight studies assessed this test in conversion from MCI to Alzheimer´s disease dementia. Only one study provided information about the MMSE and conversion from MCI to vascular dementia. For conversion from MCI to dementia in general, the accuracy of baseline MMSE scores ranged from sensitivities of 23% to 76% and specificities from 40% to 94%. In relationship to conversion from MCI to Alzheimer's disease dementia, the accuracy of baseline MMSE scores ranged from sensitivities of 27% to 89% and specificities from 32% to 90%. Only one study provided information about conversion from MCI to vascular dementia, presenting a sensitivity of 36% and a specificity of 80% with an incidence of vascular dementia of 6.2%. Although we had planned to explore possible sources of heterogeneity, this was not undertaken due to the scarcity of studies included in our analysis. Our review did not find evidence supporting a substantial role of MMSE as a stand-alone single-administration test in the identification of MCI patients who could develop dementia. Clinicians could prefer to request additional and extensive tests to be sure about the management of these patients. An important aspect to assess in future updates is if conversion to dementia from MCI stages could be predicted better by MMSE changes over time instead of single measurements. It is also important to assess if a set of tests, rather than an isolated one, may be more successful in predicting conversion from MCI to dementia.

Wernicke-Korsakoff syndrome not related to alcohol use: a systematic review

ObjectiveAlthough Wernicke-Korsakoff syndrome (WKS) is a common condition, diagnosis remains difficult. WKS not associated with alcohol is rare and thought to present differently to alcohol-related WKS. We conducted a systematic...

Синдром умеренных когнитивных расстройств

Синдром умеренных когнитивных расстройств

Depressive symptoms, cognitive impairment, and metabolic syndrome in community-dwelling elderly in Southern Taiwan.

Metabolic syndrome and depression are both thought to be associated with cognitive impairment in the elderly. Metabolic syndrome is also correlated with depression. We examined their possible pathways in a population-based sample. We recruited 300 older community participants from Southern Taiwan. Demographics, medical history, severity of depressive symptoms, cognitive function, apolipoprotein genotyping, and lipid profile were collected. The presence of metabolic syndrome was confirmed with the Third Report of the National Cholesterol Education Program's Adult Treatment Panel. Possible relationships between metabolic syndrome, depressive symptoms, and cognitive dysfunction were explored using logistic regression and structured equation modelling. When gender, age, education, marital status, and apolipoprotein genotype were adjusted for logistic regression, metabolic syndrome and depressive symptoms were independent and significant predictors of cognitive dysfunction for community-dwelling elderly. In structural equation modelling, metabolic syndrome and depressive symptoms were correlated to each other, and both contributed to the presence of cognitive dysfunction. Depressive symptoms and metabolic syndrome are independently associated with cognitive impairment among community-dwelling elderly.

Biomarkers in the diagnosis and management of Alzheimer’s disease

Traditionally Alzheimer's disease (AD) has been diagnosed and its course followed based on clinical observations and cognitive testing, and confirmed postmortem by demonstrating amyloid plaques and neurofibrillary tangles in the brain. But the growing recognition that the disease process is ongoing, damaging the brain long before clinical findings appear, has intensified a search for biomarkers that might allow its very early diagnosis and the objective assessment of its responses to putative treatments. At present at least eight biochemical measurements or scanning procedures are used as biomarkers, usually in panels, by neurologists and others. The biochemical measurements are principally of amyloid proteins and their A-beta precursors, or of tau proteins. Brain atrophy can be assessed by means of structural magnetic resonance imaging (sMRI), and decreased blood flow and metabolism can be estimated by functional magnetic resonance imaging (fMRI). [18F]fluorodeoxyglucose-positron emission tomography (FDG-PET) is used to measure the brain's energy utilization and to infer synaptic number. Impaired connectivity between brain regions is indicated by diffusion tensor imaging (DTI), while magnetic resonance spectroscopy (MRS) provides metabolic markers of diminished cell number. Additional proposed biomarkers utilize electroencephalography (EEG) and magnetoencephalography (MEG) for quantifying impairments in connectivity. Genetic analyses illustrate the heterogeneity of disease processes that can cause cognitive impairment syndromes. Recent observations awaiting confirmation suggest that levels of some plasma phospholipids can also be biomarkers of AD and that reductions in these levels can enable the accurate prediction that a cognitively normal individual will go on to develop MCI or AD within 2 years.

Cognitive Impairment and Obstructive Sleep Apnea Syndrome in Early Postmenopausal Women

Cognitive Impairment and Obstructive Sleep Apnea Syndrome in Early Postmenopausal Women

Delayed onset of dementia and parkinsonism in a postoperatory hypoparathyroidism case

Introduction. Brain imaging is mandatory for dementia diagnosis. In various guidelines and clinical studies MRI stands as the first choice, with the highest sensitivity and specificity. Our goal here is to show the exception to the rule. CT remains an imaging method important for diagnosis of pathology characterized by basal ganglia calcifications. Case history. A female patient, aged 60 years, came to the hospital with symptoms of mild cognitive impairment and parkinsonian syndrome. A medical history of hypertension and total thyroidectomy were recorded. The first imaging option for patient was to perform a brain MRI, which did not bring any information about the cause of dementia. Fortunately a CT was performed as well and bilateral basal ganglia massive calcifications were seen, which were due to total thyroidectomy / parathyroidectomy in the past. Conclusion. To diagnose secondary cognitive disorders of basal ganglia calcifications a standard head CT seems to be the method of choice.

Prognosis of Progressive Cognitive Deficit in Elderly Patients with Mild Cognitive Impairment Receiving Long-Term Treatment (3-year observations)

The aim of the present work was to assess individual prognoses for Cerebrolysin treatment efficacy in mild cognitive impairment syndrome (MCIS) and to identify the most informative tests for prognosticating the development of dementia. A total of 53 patients with the amnestic type of MCIS were treated with Cerebrolysin for three years with regular neuropsychological and psychiatric clinical testing, with analysis of the results by nonparametric statistics, cluster analysis, and linear discriminant analysis. This combination of mathematical methods allowed decreases in cognitive functions to the level of dementia to be predicted. A “risk group” with a rapid decrease in cognitive functions and the threat of dementia was identified,i.e., a group with low therapeutic efficacy. Tests were ranked in terms of their prognostic value.