Deterioration Of Cognitive Status Research Articles

PROGNOSTIC ROLE OF EEG INDICATORS FOR CHANGES IN COGNITIVE PERFORMANCE IN PATIENTS IN THE EARLY AND LONG-TERM POSTOPERATIVE PERIODS OF CORONARY ARTERY BYPASS GRAFTING

Aim. To study the prognostic role of background EEG activity indicators recorded in patients in the preoperative period of coronary artery bypass grafting (CABG) for the development of cognitive impairment in the early and late postoperative periods. Methods. A total of 85 patients with coronary artery disease (CAD) who underwent CABG were included in the study. Before CABG (3-5 days) all neuropsychological testing and EEG studies were performed, at the 7-10th days and 1 year after CABG only neuropsychological testing. EEG predictors of early (n = 85) and long-term (n = 65) postoperative cognitive dysfunction were detected using the method of multiple linear regression. Results. EEG predictors of deterioration of cognitive status in the early postoperative period of CABG were basic higher values of theta-rhythm power in the posterior regions of the cortex of both hemispheres with closed and open eyes. Whereas higher preoperative parameters of beta2-rhythm biopotentials in the left frontal areas with eyes open and lower alpha-rhythm power in the left occipital parts of the cerebral cortex with eyes closed were associated with long-term postoperative cognitive dysfunction. Conclusion. associations of preoperative eeg indicators with deteriorations of cognitive status in the early and longterm postoperative periods of cabg were revealed.

ВЛИЯНИЕ ГЛУБОКОЙ АНЕСТЕЗИИ НА ВОЗНИКНОВЕНИЕ ПОСЛЕОПЕРАЦИОННОЙ КОГНИТИВНОЙ ДИСФУНКЦИИ

The profound deepening of medicamentous sleep down to the burst-suppression electroencephalography pattern is used to provide medication-based protection of brain during preventive temporary clipping of the major arteries when performing surgery due to cerebral aneurysms. There is no consensus about the effect of profound suppression of electrobiological activity on the development of post-operative cognitive dysfunction. The goal: to evaluate the impact of anesthesia with the burst-suppression electroencephalography pattern on the post-operative cognitive status of the patients with no cerebral disorders. Subjects and methods. 30 patients were enrolled into the prospective randomized study, they all had surgeries due to degenerative spinal diseases. All patients were divided into two groups. Anesthesia in the main group (Group 1) differed from the one in the control group (Group 2); it included administration of propofol till achieving suppression of the electrobiological activity of burst-suppression electroencephalography pattern during 15 minutes. Prior to the surgery and in 4 days after it, all patients had neuro-psychological tests using Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB) and numbers memorization techniques (NMT). Results. When testing in 4 days after surgery, results in the patients from Group 1 did not differ from pre-operative results of MoCA (Me before = 28, Me after = 28, Z = 0.714, p = 0.476), FAB (Me before = 18, Me after = 18, Z = 0.592, p = 0.554), memorization of numbers in the direct order (Me before = 18, Me after = 18, Z = 0.178, p = 0.859) and in the reverse order (Me before = 18, Me after = 18, Z = 0.548, p = 0.583). The results of the post-operative testing in Group 2 were compatible with pre-operative results of (Me before = 18, Me after = 18, Z = 0.459, p = 0.646), FAB (Me before = 18, Me after = 18, Z = 1.348, p = 0.178), memorization of numbers in the direct order (Me before = 18, Me after = 18, Z = 0.21, p = 0.843) and in the reverse order (Me before = 18, Me after = 18, Z = 0.809, p = 0.418). None of the tests detected significant differences between the Groups (U = 88, p = 0.319, Z = 0.995 for MoCA; U = 102.5, p = 0.644, Z = 0.394 for FAB; U = 92.0, p = 0.407, Z = -0.829 for memorization of numbers in the direct order, and U = 33.5, p = 0.62, Z = 0.572 for memorization of numbers in the reverse order). Conclusion. Anesthesia with burst-suppression electroencephalography pattern as a model of medication-based cerebral protection during temporary clipping of the major arteries does not cause the deterioration of cognitive status in the patients who had no cerebral pathology initially.

Difference of clinical course between cases with bone union and those with delayed union following osteoporotic vertebral fractures.

Delayed union following osteoporotic vertebral fracture displayed as an intravertebral cleft on plain X-rays was reported to be a factor for prolonged severe pain. However, the difference of clinical course between bone union and delayed union cases still remains unclear. The purpose of this study was to identify how OVF delayed union following conventional conservative treatment influences the clinical course with a prospective multicenter study. A total of 324 OVF patients from 25 institutes in Osaka, Japan, were included in the study. At the 6-month follow-up after initial visit to each institute, the patients were classified into bone union and delayed union groups based on plain X-ray findings. The outcome assessments included a VAS for back pain, SF-36 for quality of life (QOL), severity of bed-ridden state for activities of daily living (ADL), MMSE for cognitive functions, and degree of vertebral collapse on plain X-rays. Overall, 280 patients were included into the union group and 44 into the delayed union group. The VAS score at 6months was significantly worse in the delayed union group (p = 0.01). The scores for the SF-36 scales of physical functioning and bodily pain at 6months were significantly lower in the delayed union group (p = 0.019, p = 0.01, respectively). The percentage of nearly or completely bed-ridden patients was significantly higher in the delayed union group. The percentage of newly developed cognitive impairment was significantly higher in the delayed union group (p = 0.02). Progression of vertebral collapse during the 6-month follow-up was more pronounced in the delayed union group (p < 0.01). The present results revealed that delayed union following OVF causes prolonged pain, QOL impairment, ADL impairment, cognitive status deterioration, and vertebral collapse progression.

Adherence to the Mediterranean diet pattern, cognitive status and depressive symptoms in an elderly non-institutionalized population.

Scientific evidence indicates that adherence to the Mediterranean diet protects against the deterioration of cognitive status and depressive symptoms during aging. However, few studies have been conducted in elderly non-institutionalized subjects. This study evaluated the relation between the adherence to the Mediterranean dietary pattern and cognitive status and depressive symptoms in an elderly population over 75 years. A cross-sectional study was conducted in a Mediterranean city (Garrucha, Spain) in 79 elderly people over 75 (36 men and 41 women). Adherence to the Mediterranean dietary pattern was determined using the Mediterranean Diet Adherence Screener (MEDAS). Cognitive function was determined by the Mini Mental State Examination (MMSE), and depressive symptoms were assessed by the Geriatric Depression Scale (GDS). Most of population showed a very high adherence to the Mediterranean diet pattern and optimal cognitive and affective status. They consumed olive oil as their main source of fat, high levels of fish and fruit, low levels of foods with added sugars, and a low consumption of red meat. A significant relation between the MEDAS and MMSE scores was found. However, no relationship was observed between the MEDAS and GDS. The Mediterranean diet pattern was positively related with the cognitive function, although the infl uence of a healthy dietary pattern on the symptomatology of depression was unclear. However, an effective strategy against cognitive function and depression would be to improve physical activity rates, establish lifelong healthy eating habits, and consume a nutritionally-rich diet in order to enhance quality of life of the elderly.

Subsyndromal Delirium and Its Determinants in Elderly Patients Hospitalized for Acute Medical Illness

In older individuals, acute medical illnesses and admission to hospital are often associated with a deterioration of cognitive status, also in the absence of dementia and full-blown delirium. We evaluated the prevalence of subsyndromal delirium (SSD) and its correlates in a sample of elderly medical inpatients. From 763 consecutive inpatients, 325 participants with known dementia or delirium were excluded, whereas 438 (mean age: 80.6 years; female participants: 60.1%) were enrolled. SSD was diagnosed within 48 hour from admission, when at least two DSM-IV delirium criteria including disorientation, attention or memory deficit, altered level of consciousness, or perceptual disturbances were present. Cognitive performance was evaluated by Mini Mental Status Examination (MMSE). General, clinical, and laboratory parameters were also registered. One hundred and sixty-six patients (37%) had SSD. Compared with controls, SSD patients were older individuals, had less formal education, higher comorbidity, lower hemoglobin/lymphocytes counts, and higher creatinine levels. A trend toward higher prevalence of previous stroke and widowhood was observed. A MMSE score of less than 24/30 identified SSD with 88% sensitivity and 78% specificity. In SSD patients, MMSE independently correlated with years of education, high-sensitivity C reactive protein levels, and O2 arterial saturation (model adjusted r (2) = 0.30, p = .001); conversely, only years of education were associated with MMSE in controls (adjusted r (2) = 0.06, p = .01). Our data suggest that SSD is common in hospitalized older medical inpatients, and low MMSE score might be useful for identification of participants at risk of SSD. Current inflammatory response and reduced O2 arterial saturation were the only independent determinants of cognitive performance in SSD patients.

Criterios de fragilidad del adulto mayor. Estudio piloto

Objective To measure the frailty of people 75 years or over and who live in their own homes based on Fried's criteria and modified by Ávila-Funes. Design Pilot study of cross-sectional design. Site Primary Health Care Centres (7) in the city of Lleida. Participants A probabilistic sample was selected for every stratum. The total sample was 323 individuals. Primary measurements Socio-demographic characteristics, measurement of the five frailty criteria (involuntary lose of weight, low energy or exhaustion, slow mobility, muscle weakness, low physical activity), and geriatric assessment scales (Charlson Index, Pfeiffer's Test, Katz Index, Lawton and Brody Index, MNA Test and CES-D scale). Results The prevalence of frailty was 8.5%. Factors associated with frailty were, female sex and low monthly income. It was observed that if the frailty increases, there is deterioration of cognitive status, activities of daily living and nutritional status. There is also higher morbidity. Frailty criteria scores showed a significant correlation with geriatric assessment scales scores. Conclusions The prevalence of frailty in elderly people is similar to those in other studies that have used the same criteria. The measurement of frailty criteria in this study demonstrates a better ability for transcription of results. A frailty study using specific markers enhances prevention and improvement of new intervention programs.