Degree Of Cognitive Dysfunction Research Articles

Longitudinal study on the trajectory and influencing factors of cognitive dysfunction in lung transplantation patients

IntroductionLung transplantation is an effective method for treating end-stage lung disease. It prolongs the survival time of patients, improves the quality of life, and prevents the degree of mental disability. In particular, postoperative cognitive dysfunction (POCD) is one of the complications after lung transplantation. Despite this, longitudinal studies on the identification and heterogeneity of cognitive dysfunction subgroup trajectories in transplant patients are lacking. Therefore, our study aimed to evaluate the factors that influence POCD in lung transplant patients. MethodsThis prospective longitudinal study included patients who underwent lung transplantation at the transplant center of Wuxi People's Hospital from September 2022 to September 2023. Patients with lung transplants were evaluated at 8 days (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after the operation. The general information questionnaire evaluated cognitive functions using the Montreal Cognitive Assessment (MoCA) numerical rating scale (NRS) and the digital pain assessment to obtain the POCD values. Latent category growth model (LCGM) analysis was used to identify heterogeneous POCD subgroups in the four observation periods. Univariate and logistic regression analyses were used to identify factors affecting POCD classification and independent risk factors. ResultsBased on clinical outcomes, 79 patients completed all four surveys, of whom 16 were lost during the follow-up period (loss rate, 16.8%). The cognitive function by MoCA NRS score was 14.18 ± 5.32 points on day 8 (T1), 22.51 ± 5.13 points at 1 month (T2), 25.44 ± 3.61 at 3 months (T3), and 27.04 ± 3.03 points at 6 months (T4) after lung transplantation, showing an increasing trend. The LCGM, used to fit the trajectory of MoCA scores, observed a heterogeneous trajectory of changes in lung transplant patients. Based on this analysis, patients could be divided into two categories: those with high risk (25,32%) and those with low risk (54,68%). The single-factor analysis identified that POCD values were affected by early postoperative rehabilitation exercise, degree of pain, intensive care unit (ICU) stay time, and donor lung cold ischemia time (all P < 0.05). Using the low-risk group as the reference class, logistic regression analysis showed that the model could correctly classify the subjects. ConclusionOur 6-month observation of lung transplant patients showed that the degree of cognitive dysfunction had an overall downward trend and that patients could be divided into two trajectories of high and low risk for POCD. Early postoperative rehabilitation exercise, degree of pain, ICU stay time, and donor lung cold ischemia time were all influencing factors for POCD in lung transplant patients.

An exploratory study of delayed flash visual evoked potential P2 wave latency in subcortical arteriosclerotic encephalopathy

BackgroundPatients with cognitive dysfunction may present with significantly prolonged the P2 wave latency of flash visual evoked potential. However, no studies have been reported on whether the P2 wave latency of flash visual evoked potential is prolonged in patients with subcortical arteriosclerotic encephalopathy (SAE).ObjectiveTo examine the relationship between flash visual evoked potential P2 wave latency (FVEP-P2 wave latency) and cognitive impairment in patients with SAE.MethodsOverall, we recruited 38 SAE patients as the observation cohort (OC) and 34 healthy volunteers as the control cohort (CC). We measured the FVEP-P2 wave latency for both groups. The SAE patients’ cognitive abilities were evaluated via mini-mental state examination (MMSE) and the association between the latency of FVEP-P2 and MMSE score was explored by Pearsons´s correlation test.ResultsThere is no significant difference between OC (21 males and 17 females; 68.6 ± 6.7 years of age and 9.6 ± 2.8 years of education) and CC (19 males and 15 females; 65.3 ± 5.9 years of age and 10.1 ± 2.6 years of education) in gender and age composition and education level. The FVEP-P2 wave latency of the CC group was (108.80 ± 16.70) ms and the OC FVEP-P2 wave latency was (152.31 ± 20.70) ms. The OC FVEP-P2 wave latency was significantly longer than the CC (P < 0.05). In terms of MMSE scores, the MMSE scores of CC was (28.41 ± 2.34), and that of OC was (9.08 ± 4.39). Compared to the CC, the OC MMSE score was significantly lower (P < 0.05). In addition, the FVEP-P2 wave latency was inversely related to the MMSE (r = -0.4465, P < 0.05) in SAE patients.ConclusionThe FVEP-P2 wave latency wave latency was significantly prolonged in SAE patients and strongly associated with the degree of cognitive dysfunction.

Fatigue, cognition and inflammatory biomarkers changes in response to computer-based cognitive training in multiple sclerosis patients: A randomized controlled trial.

Fatigue, cognition problems and multiple sclerosis (MS) inflammatory processes became main quality of life indicators and points of clinical significance in MS practice. The purpose of the current study was to investigate the changes in primary fatigue level, degree of cognitive dysfunction and level of inflammatory biomarkers in response to computer-based cognitive training in patients with MS. A total of 40 remitting-relapse MS patients were divided into two groups, both groups were suffering cognitive decline, primary fatigue with elevated serum levels of the inflammatory biomarkers. Patients in the control group (GA) underwent conventional physical therapy program for MS including aerobic training, resistive training and a flexibility program in addition to placebo cognitive sessions, study group patients (GB) received an intensive computer-based cognitive program using the REHACOM software in addition to the same conventional physical therapy program as in GA. Significant decrease in the level of primary fatigue and in the serum levels of inflammatory biomarkers in GB patients compared to GA, as well as a remarkable improvement in the cognitive abilities in favor to the study group (GB) (p < 0.05). The addition of computer-based cognitive training in the rehabilitation program of MS patients is efficient in improving disease course via decreasing fatigue levels, enhancing cognitive abilities and reducing level of inflammatory biomarkers.

Discrepancy Between the Degree of Cognitive Impairment and Brain Imaging Abnormalities in Alzheimer's Disease Patients Is Associated with Cognitive Reserve.

In Alzheimer's disease (AD) patients, the severity of cognitive impairment is thought to correlate with the degree of brain imaging abnormalities. However, some patients show only mild cognitive deficit, despite severe brain atrophy on magnetic resonance imaging (MRI) or marked hypoperfusion in the cerebral cortices on single-photon emission computed tomography (SPECT). This suggests that cognitive reserve (CR) can compensate for the clinical manifestations of AD in patients with extensive brain pathology. We aimed to determine whether this discrepancy between cognitive and imaging findings is associated with CR. Factors associated with the discrepancy between the degree of cognitive impairment and MRI (medial temporal lobe atrophy) and SPECT (posterior cerebral hypoperfusion) findings were analyzed in 135 patients with probable AD. Factors as proxies for CR included education, occupation, leisure activity, comorbidities, frailty, and other demographics. The discrepancy index (DI) was calculated as the difference between the degree of imaging abnormalities and the degree of cognitive dysfunction. Multiple regression analysis showed that leisure activity and education were significantly associated with the discrepancy between cognitive and imaging findings. When the level of CR was determined based on leisure activity and education, the high-CR group showed a significantly larger DI than the moderate- and low-CR groups. The discrepancy between cognitive and imaging findings in patients with AD is associated with CR, measured using a combination of two indicators, i.e., leisure activity and education. Therefore, lifestyle interventions may delay the appearance of clinical symptoms resulting from underlying AD pathology, by increasing CR.

Efficacy of Virtual Reality Induced Environmental and Habitual Navigation on Psychological, Cognitive Function that Impacts on Physical Recovery in Patients with Stroke

[Background] Cognitive dysfunction after a stroke is normal, but it is underdiagnosed and has a badprognosis. In 40-70 percent of stroke survivors, there is a degree of cognitive dysfunction. Similarly,psychometric issues such as anxiety and depression are normal following stroke but are mostly untreated,resulting in a patient’s poor quality of life. Whereas it also has an effect on a person’s rehabilitation. Theuse of traditional methodology has certain beneficial effects, but it is not necessarily handled with theindividual’s own interests in mind. Virtual reality, on the other hand, seems to play a role in dealing withsuch issues, especially where they are linked to neurological disorders. Virtual reality navigation has thepotential to enhance basic cognitive functions such as visuo-spatial perception, executive performance, andattention, both of which can affect one’s psychological state and aid in functional rehabilitation. Cognitivedeficits and social issues must be addressed because they have a detrimental impact on functional abilitiesand quality of life.[Methodology] Twenty-three participants between the ages of 40 and 60 with a stroke diagnosis were chosen.Participants were split into two groups: Group A, which received Virtual Reality induced environmental andhabitual navigation as well as Conventional Physiotherapy, and Group B, which received ConventionalPhysiotherapy as well as cognitive training and relaxation for 4 weeks of duration. The Montreal CognitiveAssessment (MoCA), Hamilton Anxiety Rating Scale (HARS), Hamilton Depression Rating Scale (HDRS),and Functional Independence Measure (FIM) were used to conduct pre and post intervention evaluations.[Conclusion] The study found that combining virtual reality-induced environmental and habitual navigationwith conventional physiotherapy improves cognitive control, psychological function, and functional recoveryin stroke patients more effectively than treating them with conventional physiotherapy alone.

Neurodevelopmental disorders: 2021 update.

One of the current challenges in the field of neurodevelopmental disorders (NDDs) is still to determine their underlying aetiology and risk factors. NDDs comprise a diverse group of disorders primarily related to neurodevelopmental dysfunction including autism spectrum disorder (ASD), developmental delay, intellectual disability (ID), and attention-deficit/hyperactivity disorder (ADHD) that may present with a certain degree of cognitive dysfunction and high prevalence of neuropsychiatric outcomes. Last year, advances in human genomics have begun to shed light on the genetic architecture of these disorders and large-scale sequencing studies are starting to reveal mechanisms that range from unique genomic DNA methylation patterns (i.e. "episignatures") to highly polygenic conditions. In addition, the contribution of de novo somatic mutations to neurodevelopmental diseases is being recognized. However, progressing from genetic findings to underlying neuropathological mechanisms has proved challenging, due to the increased resolution of the molecular and genetic assays. Advancement in modelling tools is likely to improve our understanding of the origin of neurodevelopmental disorders and provide insight into their developmental mechanisms. Also, combined in vivo editing of multiple genes and single-cell RNA-sequencing (scRNA-seq) are bringing us into a new era of understanding the molecular neuropathology of NDDs.

USE OF VALPROIC ACID FOR THE TREATMENT OF NEUROPSYCHIATRIC SYMPTOMS IN ACQUIRED BRAIN INJURIES

Acquired brain injuries are often accompanied by a series of neuropsychiatric disorders. A wide range of pharmacological agents are used to treat neuropsychiatric symptoms. However, a more indepth review of the agents used indicates that there are in fact relatively few procedures recommended for use. Anticonvulsants including valproic acid, are of particular interest. This research aimed to assess the efficacy and safety of valproic acid, as based on a naturalistic observation of patients with various forms of acquired brain injury and who had displayed neuropsychiatric symptoms. The study group consisted of individuals (N = 43) who were treated with valproic acid as the first choice of drug. Both the initial dose and its size during further treatment, as well as the treatment method, were determined based on medical indications. The mental state of the patients was assessed twice: at the time of enrolment for the study and after 12 months. The Cohen-Mansfield Agitation Inventory (CMAI) was used for the assessment. In addition, the degree of cognitive dysfunction was assessed during the baseline study using the MMSE scale. Eventually, 24 individuals were accepted for statistical analysis. They were re-examined after 12 months and took only valproic acid during that period. 24 out of 43 individuals qualified for the study completed the 12-month observation period. 11 respondents were excluded from the study due to their inappropriate tolerance. The reported side effects were of a temporary nature (except for hair loss) and of a mild or moderate intensity. It was observed that aggressive and impulsive behaviours were significantly reduced in the study group. The positive therapeutic effect concerned all categories in the CMAI scale, except for verbal aggression. The therapeutic effect of the valproic acid was varied depending on the degree of cognitive impairments. Statistical significance for higher MMSE scores was obtained only for the category of non-aggressive verbal disorders. On the other hand, in the case of lower MMSE scores a significant reduction was observed both in the categories of non-aggressive and aggressive physical behaviours, as well as for the overall CMAI scale result. The results obtained seem to indicate a satisfactory efficacy and acceptable tolerance of valproic acid in the treatment of the neuropsychiatric symptoms accompanying acquired brain injuries.

P1419U- SHAPED ASSOCIATION OF SERUM PARATHYROID HORMONE AND COGNITIVE DYSFUNCTION IN MAINTENANCE HAEMODIALYSIS PATIENTS

Abstract Background and Aims Primary hyperparathyroidism (HPT) is linked with several cognitive and affective disorders in the general population that tend to improve following parathyroidectomy. Most end- stage renal disease (ESRD) patients treated with maintenance haemodialysis (MHD) have 2ry/3ry HPT encompassing a broad range of serum intact parathyroid hormone (S. iPTH) values. They commonly suffer some degree of cognitive dysfunction (CODY) that impairs medication adherence and quality of life. This CODY results from the interplay of multiple factors, including HPT. However, relative hypoparathyroidism may as well cause CODY in the setting of adynamic bone disease and increased cerebrovascular calcification. Therefore, the relationship between S. iPTH and CODY in MHD patients needs to be clearly characterized across the whole spectrum of iPTH values. Method Seventy two stable ESRD patients (39 males, median age 50y) treated with thrice weekly low flux MHD for &amp;gt; 6 months underwent Montreal cognitive assessment- basic version (MoCA-B) and pre-dialysis assessment of S. iPTH, vitamin D3, alkaline phosphatase, urea, creatinine, calcium, phosphorus and haemoglobin (Hb). Results CODY, defined by a MoCA-B score &amp;lt; 24/30, occurred in 37/72 (51%) patients. MoCA-B score had a statistically significant positive correlation with Hb level. A quadratic inverted U-shaped curve provided the best estimate for the relation between S. iPTH and MoCA-B score (P = 0.019, Figure). Among patients in the highest S. iPTH tertile, S. iPTH has a statistically significant negative linear correlation with MoCA-B score (r = - 0.565, P = 0.004). This correlation was attenuated but persisted after controlling for Hb level (r = - 0.516, P = 0.012). Conclusion Anaemia and HPT are important contributors to the high prevalence of CODY in MHD patients. Both markedly high and relatively low (still above normal) S. iPTH levels are associated with lower MoCA-B scores, indicating a U- shaped relation between S. iPTH and CODY. Contrary to other populations, some degree of mild (permissible) HPT is most compatible with near normal cognitive function in MHD patients. Our results emphasize the recommendation of avoiding overzealous suppression of PTH secretion in these patients.

Associations of functional, psychosocial, and medical factors with cognitive impairment in older, chemotherapy-naïve patients with early breast cancer.

12114 Background: Cognitive decline related to cancer and its treatments is a common concern among patients receiving treatment for cancer. Routine cognitive screening in oncology practice has been limited by the absence of a reliable, cancer-specific cognitive test. The Blessed Orientation Memory Concentration Test (BOMC) [1], has been incorporated in cancer-specific geriatric assessments, but there is no established cutpoint for cancer-related cognitive impairment. Recent research suggests that BOMC scores ≥ 5 may represent cognitive impairment in older patients with cancer. The purpose of this study was to identify cognitive impairment and associated characteristics in chemotherapy-naïve patients with breast cancer. Methods: Women with stage I-III breast cancer were recruited between 2009 and 2018. The BOMC (range 0-28, higher is worse function) was administered prior to chemotherapy. Associations between cognitive dysfunction (BOMC ≥ 5) and functional, psychosocial, medical variable were assessed using log binomial regression analysis. Results: In a sample of 331 women with breast cancer, the mean age was 65.2 years and 68.6% were 65 and older. Twenty-seven percent demonstrated cognitive impairment prior to treatment. Patients with Time Up and Go Test (TUG) ≥ 14 had increased risk of cognitive impairment compared to those with TUG &lt; 14 (44% vs. 23%, p = 0.0002). After controlling for demographic factors, the estimated increase in risk was 66% (RR: 1.66, 95% CI (1.20, 2.31), p = 0.002). For Medical Outcomes Survey (MOS) Physical Function, after controlling for demographic factors, each 1 point increase in physical function (range 0-20, higher is better function) was associated with a 5% decrease in risk of cognitive impairment (p = 0.0004). Conclusions: Using a newly proposed BOMC cutpoint of ≥ 5, our study identified cognitive impairment in over 25% of older, chemotherapy naïve women with breast cancer. This is similar to what has been reported using rigorous neuropsychological testing in comparable populations. Additionally, we found that this degree of cognitive dysfunction was associated with both patient-reported and clinician-assessed impairment in physical function, further supporting the clinical relevance of this new cutpoint. Reference: [1] Katzman et al. Am. J. Psychiatry. 140 (1983) 734–739.

Abstract WP488: Imaging Correlates of Vascular Cognitive Impairment After Recent Ischemia in Intracranial Atherosclerosis: Evidence From SAMMPRIS

Background: More than 50% of individuals with recently symptomatic intracranial atherosclerotic disease (ICAD) manifest cognitive dysfunction. The imaging correlates of such cognitive impairment due to large vessel disease remain largely unknown. We examined the degree of cognitive dysfunction associated with detailed quantification of MRI DWI and FLAIR lesions at baseline in the SAMMPRIS trial. Methods: Central, blinded, adjudication of baseline MRI included measurement of DWI and FLAIR lesions and corresponding volumes. Cognitive function was assayed with the Montreal Cognitive Assessment (MoCA) score (0-30). Statistical analyses were used to describe MRI lesion characteristics and the correlation with baseline MoCA score. Results: At enrollment in SAMMPRIS, baseline DWI was available in 309/451 (69%) subjects, with FLAIR in 293/451 (65%). Baseline MoCA was median 25.0 (10-30). Chronic ischemic lesion burden on FLAIR was median 2.7 cc (0-87.0), with greater extent in those older than 60 years (p=0.03) and those on anti-thrombotics (p=0.01). DWI lesion volume (median 1.45 cc, range 0-71.84) was associated with NIHSS score (p&lt;0.01), antithrombotic use (p=0.01) and time from qualifying event to enrollment (p=0.05). The number of DWI lesions (median 9, range 1-69) correlated (r=0.63, p&lt;0.01) with total volume of acute infarction and was associated with more than 7 days from qualifying event (15.3 vs. 10.7, p&lt;0.01). Chronic FLAIR lesion burden was associated with worse cognitive function or lower MoCA (r=-0.18, p=0.01) at baseline. Importantly, the volume or number of acute DWI lesions was unrelated to MoCA. Conclusions: Cognitive impairment associated with recently symptomatic intracranial atherosclerosis reflects the underlying burden of chronic, not acute, ischemia. Routine MRI, including FLAIR may inform future studies of vascular cognitive impairment in large vessel disease.

Effect of Dexmedetomidine with Different Anesthetic Dosage on Neurocognitive Function in Elderly Patients After Operation Based on Neural Network Model

This paper uses a neural network model to study the protective effect of dexmedetomidine on the anesthesia recovery period and neurocognitive function in elderly patients undergoing radical resection of colorectal cancer. Eighty-eight patients with colorectal cancer who underwent radical surgery in our hospital from January 2015 to June 2017 were randomly divided into groups: study (43cases) and control (45 cases). The study group was treated with dexmedetomidine for anesthesia. Patients in the study group were given a slow pumping dose of 1 μg/kg to prepare dexmedetomidine at a dose of 1 μg/kg. The pumping time was >10 minutes, and the dose was 0.3 μg after completion. The loading dose of 0.3 (kg·h) was maintained intraoperatively; the control group was given the same amount of saline infusion by the same infusion method. The study found that the probability of cognitive dysfunction in the study group was significantly lower than that in the control group, and the degree of cognitive dysfunction in the study group was significantly lower than that in the control group (P < 0.05). Therefore in the operation of elderly patients with colorectal cancer radical surgery, dexmedetomidine is used for anesthesia to protect postoperative cognitive function and reduce the incidence of cognitive dysfunction. Extensive promotion and application in the clinic.

P: 53 Extent of Sarcopenia Does Not Correlate With Degree of Minimal Hepatic Encephalopathy in patients on Treatment for Hepatric Encephalopathy

BACKGROUND: Minimal hepatic encephalopathy affects over half of the patients with cirrhosis. It leads to deterioration of quality of life due to cognitive deficit. Both presence of sarcopenia and portosystemic shunts have been implicated in development of minimal hepatic encephalopathy. We retrospectively assessed the significance of sarcopenia and presence of portosystemic shunts in patients with minimal hepatic encephalopathy. METHODS: Patients with cirrhosis of liver attending the liver clinic at University of Padua underwent a detailed elective outpatient assessment for neurocognitive function. This included Psychometric Hepatic Encephalopathy Score (PHES), computer based tests, and EEG. We then selected patients who underwent a computed tomography for any reason within 3 months of the neurocognitive assessment. The degree of sarcopenia and presence of portosystemic shunts was evaluated on the scan. Presence of more than one shunt was accounted and adjusted for appropriately using a physiological approach previously described. RESULTS: A total of 120 patients had a CT scan within 3 months of the neurocognitive assessment. Of these, 100 were found to be suitable for analysis. Mean age of the patients was 59 ± 9.6 yrs and 73% were males. Median Child Pugh score was 8 (IQR 6–10) and MELD was 12 (IQR 10–18). Alcohol and viral etiologies responsible for 40% and 39% cases respectively. Based on Psychometric Hepatic Encephalopathy Score (PHES), 39% had minimal hepatic encephalopathy. Medication details were available for 87 patients, 70% of whom were on some form of treatment of hepatic encephalopathy with lactulose, antibiotics, or probiotics. The degree of cognitive dysfunction (PHES) correlated significantly with education (r = 0.33), shunt size (r = −0.45), and degree of hyperammonemia (r = −0.48), but not with sarcopenia or degree of hepatic dysfunction. Correlation between total effective shunt size and PHES was more pronounced in women (r = −0.68). Upon multivariate analysis, none of these variables predicted PHES. EEG mean dominant frequency correlated significantly with total effective shunt size (r = −0.30), ammonia (r = −0.34), and Child-Pugh score (r = −0.38). None of the parameters significantly correlated with critical flicker frequency. There was no difference in the degree of sarcopenia among patients with and without MHE or history of overt HE. Moreover, degree of sarcopenia did not correlate with PHES, critical flicker frequency, ammonia level, or Child-Pugh score. Effective size of portosystemic shunt was higher in patients with MHE. CONCLUSIONS: Among patients with cirrhosis on anti-encephalopathy treatment, presence of sarcopenia does not correlate with neurocognitive parameters. Presence of large portosystemic shunts correlated with neurocognitive impairment.

CSF chitinase proteins in amyotrophic lateral sclerosis

ObjectiveTo evaluate the classifier performance, clinical and biochemical correlations of cerebrospinal fluid (CSF) levels of the chitinase proteins Chitotriosidase-1 (CHIT1), Chitinase-3-like protein 1 (CHI3L1) and Chitinase-3-like protein 2 (CHI3L2) in...

Type 2 diabetes and cognitive dysfunction in minorities: a review of the literature

ABSTRACTObjectives: The purpose of this review was to summarize the current status of knowledge regarding cognitive dysfunction and diabetes in minorities. Literature on the interaction of cognitive dysfunction and diabetes was analyzed to (a) examine the number and characteristics of studies in minority populations; (b) identify tests used to assess cognitive function in diabetes; (c) consider the impact of diabetes on cognitive function; and (d) assess the moderators of the association between diabetes and cognitive function.Design: A literature review and thematic analysis was conducted. Studies were mapped to describe their design, target population, instruments used, and the physiologic, psychosocial, and socioeconomic findings related to cognitive function and diabetes. Twelve studies met the inclusion criteria.Results: Hispanics were studied more than any other ethnic group. Rates and degree of cognitive dysfunction were more prevalent in minorities than non-Hispanic whites. Overall, 28 different tests were administered to evaluate cognitive function. There was some variation among findings regarding the relationship of cognitive function and diabetes. Risk for cognitive decline was associated with the diagnosis of diabetes alone, regardless of whether the diabetes was treated or untreated. Higher rates of discrimination were associated with greater cognitive declineConclusion: Given the context of minority health, there is a potential for higher negative health impact due to the increased prevalence of diabetes and cognitive dysfunction and other related health disparities. Reduction of physiological risk factors for diabetes, consistency in assessment, as well as elimination of structural barriers such as access to care should be helpful in decreasing the incidence of both diabetes and cognitive decline. More research is needed to determine whether the observed differences are modifiable and to identify factors involved in the interaction of diabetes and cognitive decline—not only physiological factors, but factors related to socioeconomic status and quality of life.

Inappropriate behaviors and hypersexuality in individuals with dementia: An overview of a neglected issue.

Behavioral and psychological symptoms of dementia are very common in patients affected by dementia, and are associated with high rates of institutionalization. Behavioral and psychological symptoms of dementia consist of aggressive behavior, delusions, hallucinations, depression, apathy, wandering, stereotyped and inappropriate sexual behavior. Interestingly, the latter has been reported to be relatively uncommon, but causing immense distress to patients and their caregivers. The genesis of inappropriate behavior is considered a combination of neurological, psychological and social factors. Although assessment is mainly carried out by clinical observation and interviews with caregivers, the most appropriate management of behavioral and psychological symptoms of dementia, including hypersexuality, is a combination of pharmacological and non-pharmacological interventions, according to specific symptoms, degree of cognitive dysfunction and subtype of dementia. The present narrative review will mainly focus on aggressiveness, disinhibition, aberrant motor, and sexually inappropriate behavior diagnostic work-up and treatment, in an attempt to provide both the patients and their caregivers with useful information to better manage these symptoms and improve their quality of life. Space is particularly dedicated to inappropriate sexual behavior, which is still considered a neglected issue. Geriatr Gerontol Int 2017; 17: 865-874.

Serum metabolite changes of aged rats with post-anesthesia cognitive dysfunction

Objective To explore the effects of isoflurane on blood plasma metabolites (BPM) and its correlation with cognitive dysfunction. Methods Thirty female Sprague-Dawley (SD) rats were randomly divided into two groups: rats in the control group (n=10) received 80% oxygen for 2 hours (h); and rats in the isoflurane-treated group (n=20) were anesthetized with isoflurane and 80% oxygen for 2 h. Cognitive functions were examined using a Y-maze test to explore the learning times of rats. The level of blood plasma metabolites was detected through gas chromatography-mass spectrometry (GCMS). Results The learning times of rats in the isoflurane-treated group was more than the learning times of rats in the control group [(70.75±15.30) vs (45.40±11.21), P<0.05]. D-fructose, arabinofuranose, n-butylamine, and inositol significantly increased (P<0.05), respectively. Whereas, L-analine and L-proline significantly decreased (P<0.05) in isoflurane-treated rats when compared to those in the control rats (P<0.05). Moreover, plasma concentrations of d-fructose, arabinofuranose, n-butylamine, inositol, and L-proline were positively correlated with the degree of cognitive dysfunction in the isoflurane-treated rats. Conclusions Changes of plasma concentrations of inositol, and d-fructose in aged rats are useful in predicting the occurrence and progression of post-anesthesia cognitive dysfunction. Key words: Anesthesia/AE; Cognition disorders/ME; Isoflurane/AE

Conditional Tat protein brain expression in the GT-tg bigenic mouse induces cerebral fractional anisotropy abnormalities.

Cerebral white matter changes including tissue water diffusion abnormalities detected with diffusion tensor magnetic resonance imaging (DTI) are commonly found in humans with Human Immunodeficiency Virus (HIV) infection, as well as in animal models of the disorder. The severities of some of these abnormalities have been reported to correlate with measures of disease progression or severity, or with the degree of cognitive dysfunction. Accordingly, DTI may be a useful translational biomarker. HIV-Tat protein appears to be an important factor in the viral pathogenesis of HIV-associated neurotoxicity. We previously reported cerebral gray matter density reductions in the GT-tg bigenic mouse treated with doxycycline (Dox) to conditionally induce Tat protein expression. Presently, we administered intraperitoneal (i.p.) Dox (100 mg/kg/day) for 7 days to GT-tg mice to determine whether induction of conditional Tat expression led to the development of cerebral DTI abnormalities. Perfused and fixed brains from eight GT-tg mice administered Dox and eight control mice administered saline i.p. were extracted and underwent DTI scans on a 9.4 Tesla scanner. A whole brain analysis detected fractional anisotropy (FA) reductions in several areas including insular and endopiriform regions, as well as within the dorsal striatum. These findings suggest that exposure to Tat protein is sufficient to induce FA abnormalities, and further support the use of the GT-tg mouse to model some effects of HIV.

A comparative study of cognitive function following traumatic brain injury: Significance of initial Glasgow coma scale score to predict cognitive outcome

Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability all over the world. It is associated with diversities of outcomes including cognitive deficits. The worse cognitive outcome is often associated with more severe degree of TBI as measured by initial Glasgow Coma Scale (GCS) score. Materials and Methods: Present study compared the cognitive function of TBI patients having initial GCS score 9-10 with those having the initial GCS score 11-12. The assessment on Postgraduate Institute battery of brain dysfunction was conducted when the patients came for their follow-up visit at a tertiary health care facility between 6 months and 12 months of sustaining TBI. Results: There was moderate degree of cognitive dysfunction in the group with initial GCS score of 9-10 and no dysfunction in the group with initial GCS score of 11-12. Conclusion: The initial GCS score of 10 may be critical to predict cognitive deficits among TBI patients during 6-12 months of recovery period.

Aspartic acid in the hippocampus: a biomarker for postoperative cognitive dysfunction.

This study established an aged rat model of cognitive dysfunction using anesthesia with 2% isoflurane and 80% oxygen for 2 hours. Twenty-four hours later, Y-maze test results showed that isoflurane significantly impaired cognitive function in aged rats. Gas chromatography-mass spectrometry results showed that isoflurane also significantly increased the levels of N,N-diethylacetamide, n-ethylacetamide, aspartic acid, malic acid and arabinonic acid in the hippocampus of isoflurane-treated rats. Moreover, aspartic acid, N,N-diethylacetamide, n-ethylacetamide and malic acid concentration was positively correlated with the degree of cognitive dysfunction in the isoflurane-treated rats. It is evident that hippocampal metabolite changes are involved in the formation of cognitive dysfunction after isoflurane anesthesia. To further verify these results, this study cultured hippocampal neurons in vitro, which were then treated with aspartic acid (100 μmol/L). Results suggested that aspartic acid concentration in the hippocampus may be a biomarker for predicting the occurrence and disease progress of cognitive dysfunction.

Neurocognitive function in bipolar disorder: a comparison between bipolar I and II disorder and matched controls

BackgroundCognitive deficits have been documented in patients with bipolar disorder. Further, it has been suggested that the degree and type of cognitive impairment differ between bipolar I and bipolar II disorder, but data is conflicting and remains inconclusive. This study aimed to clarify the suggested differences in cognitive impairment between patients with bipolar I and II disorder in a relatively large, clinically stable sample while controlling for potential confounders.Methods67 patients with bipolar I disorder, 43 with bipolar II disorder, and 86 randomly selected population-based healthy controls were compared. A number of neuropsychological tests were administered, assessing verbal and visual memory and executive functions. Patients were in a stable phase during testing.ResultsPatients with bipolar type I and type II were cognitively impaired compared to healthy controls, but there were no statistically significant differences between the two subtypes. The strongest predictor of cognitive impairment within the patient group was current antipsychotic treatment.ConclusionsThe present study suggests that the type and degree of cognitive dysfunction is similar in bipolar I and II patients. Notably, treatment with antipsychotics - but not a history of psychosis - was associated with more severe cognitive impairment. Given that patients with bipolar I disorder are more likely to be on antipsychotic drugs, this might explain why some previous studies have found that patients with type I bipolar disorder are more cognitively impaired than those with type II.