Cognitive Impairment Complaints Research Articles

Особенности течения постковидного синдрома, его влияние на качество жизни и некоторые показатели гемостаза и обмена катехоламинов

The novel COVID-19 coronavirus infection is known to be characterized by recovery in most cases, but long-term sequelae persist in 10–20% of survivors. To date, the pathophysiologic characterization and clinical significance of the impact of SARSCoV-2 on endocrine organs, as well as the impact of the associated endocrine dysfunction on the prognosis of COVID-19 survivors, have not been fully explored and are not sufficiently reported in the literature. It has been suggested that catecholamines, especially in excessive concentrations, cause dysregulation of physiologic cascades, which may be closely related to unfavorable outcomes in COVID-19. The objective of the work was to determine the diagnostic significance of hemostasis and catecholamine metabolism indices in COVID-19 patients with and without post-COVID-19 syndrome, their correlation with the reported cognitive impairments. Patients and methods. 90 patients – 14 males and 76 females – who underwent COVID-19 without consequences in the form of post-COVID-19 syndrome (PCS) were examined, and the main group included patients with PCS. Patients underwent laboratory examination: coagulogram, determination of P-selectin level and daily urine examination with determination of catecholamines, catecholamine and serotonin metabolites (adrenaline, noradrenaline, dopamine, homovanillic acid, vanillylmindalic acid, 5-hydroxyindoleacetic acid). The main group consisted of 60 patients with PCS (9 (15%) men, 51 (85%) women, and the control group consisted of 30 patients without PCS (5 (16.7%) men, 25 (83.3%) women. Patients in the control group more often carried COVID-19 asymptomatically or in a non-serious form without lung damage, while patients in the main group with lung damage in 21.7% of cases. Results. The duration of PCS ranged from 4 to 36 months at the time of examination, with a median of 24 months. Its manifestation was maximal in 43.3%. Decreased quality of life associated with COVID-19 was noted by 53.3% of patients in the main group. Complaints of cognitive impairment (CI) were the most frequent in the structure of PCS in 53 patients (88.3%). The duration of CI was less than a year in 21.7%, one to two years – 15%, two and more years – 55%. Evaluation of CI severity on a five-point scale: 1 point – 10%, 2 point – 20%, 3 point – 35%, 4 point – 18,3%, 5 point – 8,3%. The predominant CI patterns were impaired concentration 78.3%, (24 [12; 35.5] months), memory 71.7%, (24 [10.5; 35.5] months), lethargy 53.3%, (12 [6; 24] months), brain fog 51.7%, (12 [7; 24] months). In the main group, 30% of patients and 10% of patients in the control group (p = 0.034) had CI according to MoCA scale (less than 26 scores). Patients in the main group with CI according to MoCA scale presented problems for 2 or more years in 55.6% of cases, less than a year – 22.2%, from a year to 2 years – in 11.1%. The presence of at least 1 symptom was noted by 88.3% of respondents. According to the results of laboratory methods, the median level of adrenaline in daily urine was higher in the main group (p = 0.025). No statistically significant difference was found in the study of hemostasis parameters between the two groups. Key words: hemostasis, catecholamines, quality of life, post-coital syndrome, scales

Role of Magnetic Resonance Imaging in Dementia

Background: Dementia is a condition of elderly individuals, marked with emotional and cognitive disabilities which are severe enough to impair their routine daily life and its quality. It is mainly a disease affecting elderly population with an approximate prevalence rate of 1% at the age of 60 years and quadruples every 10 years, up to 30%–50% by the age of 85 years. There are about 5.5 crore people suffering with dementia with more than 60% in developing countries.To overcome this, a multipronged strategy with timely diagnosis is the need of the hour. Materials and Methods: The present study was conducted at the Department of Radiodiagnosis and Department of Psychiatry of J. N. Medical College and Hospital, Aligarh, over a period of 2 years. Forty-five patients in the age group of more than 55 years who presented with the complaints of cognitive impairment and were referred for magnetic resonance imaging (MRI) head after clinical examination and Mini–Mental State Examination (MMSE) score assessment were included in the study. On MRI images are assessed using the Global Cortical Atrophy (GCA) scale, medial temporal lobe (MTL) atrophy scale, and Fazekas Scale, then findings are correlated with clinical MMSE scores. Results: There were 45 patients with the age group of more than 50 years, among 66.67% of patients were males and 33.33% of patients were females. In 60.00% of patients, socioeconomic status was lower middle class, 46.67% of patients were illiterate followed by studied till primary school (22.22%). In 66.67% of patients, mini–mental score examination score was mild. Among the imaging scales, 82.22% of patients showed moderate GCA scale; in 55.56% of patients, interpretation of MTL atrophy scale was widening of choroid fissure and temporal horn of lateral ventricle. 33.33% of patients showed Fazekas 3 Scale with large confluent lesions. All these imaging scales showed a significant negative correlation with MMSE scores. Conclusion: MRI plays an important role in the assessment of structural changes in patients presenting with cognitive impairment as well as it points toward the diagnosis of certain type of dementia depending on the involvement of specific areas or lesions and their distribution in the cerebral hemispheres. Visual assessment using various scales has helped in assessing the severity as well as possible type. There has been establishment of significant correlation between the MRI scales of atrophy and clinical MMSE scoring system.

Creación y diseño de un test para la evaluación de la apraxia de los miembros superiores (EULA) basado en un modelo cognitivo: un estudio piloto

Apraxia is regarded as neurological disorder characterized by a loss of ability to execute and carry out skilled movements and gestures despite intact motor and sensory systems, coordination, and comprehension. As reflected in the specialized literature, there are currently few tests that provide a global evaluation of this syndrome. This research created and designed a test for the Evaluation of Upper Limb Apraxia (EULA), based on theoretical models of apraxia. A sample of 57 patients was selected with subjective cognitive manifestations (complaints of cognitive impairment) and 39 subjects without cognitive impairment. Both groups were given the EULA test as well as other tests. The structure of the EULA was verified with principal components factor analysis, and the reliability and validity of this instrument were also calculated. The factor analysis classified all of the items in the test in nine factors with an explained total variance of 69.91%. The high reliability of the test was reflected in a Cronbach's alpha of 0.929 and a Guttman split-half coefficient of 0.870. The construct validity was also satisfactory as shown in the significant correlation of six of the nine factors in the test with two other well-known apraxia subtests. The healthy subjects had a higher test score than the subjects with complaints of cognitive impairment, which confirmed the reliability and construct validity of the EULA.

Videoconference diagnosis and management of Choctaw Indian dementia patients

This study reports a 5-year experience using videoconference (VC) technology in diagnosing and treating adult members of the Choctaw Nation with symptoms or complaints of cognitive impairment. Patients were given the option of a VC session or a face-to-face evaluation in the clinic. Before their VC session, patients underwent neuropsychological testing, Clinical Dementia Rating, Geriatric Depression Scale and Neuropsychiatric Inventory, brain computed tomography, and routine blood tests. Physical observations made by VC included eyesight, hearing, facial expression, gait and station, coordination, tremor, rapid alternating movements, psychomotor activity, and motor tests of executive function. Cogwheeling and rigidity were tested by our on-site nurse, who also obtained vital signs as indicated. Between January 2005 and March 2010, there were 47 clinics, 171 visits, and 85 unique patients. There were 52 new evaluations and 119 follow-up visits. The number of visits ranged from one to eight and the length of follow-up from 1 month to 4.5 years. The no-show rate for all VC sessions in 2009 was 3%, and only two subjects in 5 years refused further VC visits. Once cultural barriers are dealt with, VC-based diagnosis and treatment of adults with cognitive disorders who live in remote areas is feasible and well accepted by patients and families.

Relationship of Leukoaraiosis to Cognitive Decline and Cognitive Aging

Leukoaraiosis (LA) is a common finding on MRI scans of the elderly. However, its exact relationship to cognitive decline and dementia is in dispute. Because LA involves the paracallosal white matter, we sought to determine if LA, uncomplicated by ischemic lesions or complaints of cognitive impairment, is associated with cognitive loss or difficulties with interhemispheric integration of behavioral functions. Two hundred fifty-seven MRI scans with deep white matter changes were screened. After a chart review, 38 patients had uncomplicated LA, and 31 gave informed consent to undergo cognitive and behavioral testing. LA severity was not related to any of the cognitive or behavioral assessments. However, some dependent measures showed medium effect sizes that were in keeping with published findings, indicating that LA has a marginal impact on cognition. In comparison, robust relationships with age were found for certain tasks, suggesting that our cohort size was sufficient to detect meaningful clinical relationships. Based on statistical interpretations using effect sizes, LA severity may be better viewed as a biomarker for physiological brain aging that is in advance of chronological age, leaving the elderly individual at greater risk for developing dementia.

Patients Who Can't or Won't Work: How to Assess Impairment

Patients Who Can't or Won't Work: How to Assess Impairment

Cognitive Functioning and Magnetic Resonance Imaging in Chronic Fatigue

This study examines whether cognitive dysfunction in chronic fatigue may be accounted for by depression and anxiety or is due to brain pathology evident on magnetic resonance imaging (MRI). Twenty-six subjects with chronic fatigue, with and without coexisting depression, and 18 age-matched normal controls were recruited from primary care following a presumed viral illness six months previously. Comparison was made with 13 psychiatric controls with depressive illness on standardised cognitive tests. MRI determined the presence of cerebral white-matter lesions. No substantial differences in performance were shown between subjects with chronic fatigue, most of whom met the criteria for chronic fatigue syndrome, and controls. Subjective cognitive dysfunction increased with psychopathology. White-matter lesions were found in a minority from all groups. Improvement in fatigue and depression coincided with improved performance on cognitive measures. Subjective complaints of cognitive impairment are a prominent feature of chronic fatigue, but objective cognitive and MRI abnormalities are not. Such complaints probably reflect psychopathology rather than a post-viral process.

PSYCHIATRIC AND SOCIAL CONSEQUENCES OF LIVER TRANSPLANTATION

We assessed the prevalence of psychiatric morbidity and level of social adjustment in 32 of 34 adults who received liver transplants between 1 August 1987 and 31 July 1988 and who survived more than 6 months postoperatively. The prevalence of psychiatric morbidity was comparable with that found in the general population. Subjective complaints of cognitive impairment were common (40.6%). Liver transplant recipients were not significantly more handicapped in overall social functioning, but did show significant impairment in several role areas when compared with a community sample. Psychiatric morbidity was associated with greater social impairment, whereas liver function and other medical problems were not. We suggest that identification and treatment of psychiatric illness following transplantation needs to be better established as part of the treatment program.