Frequency Of Cognitive Impairment Research Articles

#3069 The effects of characteristics associated with dialysis on cognitive functions in patients with chronic kidney disease

Abstract Background and Aims Cognitive functions are affected in all stages of chronic kidney disease (CKD), regardless of age. This study aims to determine the effects of characteristics associated with dialysis (peritoneal dialysis (PD) or hemodialysis (HD)) on cognitive functions in patients with CKD. Method CKD patients who were followed up with PD or HD at least for six months from 3 different centers from Turkey were included in this study. For dementia screening, the AD8 dementia scoring system was used. The patients’ sociodemographic characteristics, dialysis types, dialysis access routes, weekly dialysis session numbers, dialysis adequacies, dry weights, and laboratory parameters were recorded. Results A total of 261 CKD patients, 142 of whom were male (54.4%), were included in the study (mean age: 54.46 SD: 15.297, 29.1% over 65 years of age). 151 (57.8%) of the patients were HD patients.HT (70.1%) and DM (28.7%) were the most common comorbidities. While 50% of peritoneal dialysis patients were monitored with APD, 34.4% of HD patients had a central venous catheter (CVC) for vascular access. In the study population there was no statistically significant difference in the prevalence of cognitive impairment between those over and under 65 years of age (<65 years of age 61%, >65 years of age 68%, p = 0.300). The prevalence of cognitive impairment was significantly higher in HD patients than in PD patients (p < 0.001). PD type was not related with cognitive impairment (p = 0.446). In HD patients under 65 years of age cognitive impairment was observed more frequently in the patients with CVC as vascular access (63% in patients <65 years of age with CVC, 32% in patients with AVF/AVG, p = 0.014). Conclusion Chronic kidney disease is one of the age-independent risk factors for cognitive impairment. In our study group cognitive impairment was similar in different age groups. Compared to HD patients, in PD patients less cognitive impairment was observed. In HD patients under 65 years of age using a CVC as vascular access was associated with more frequent cognitive impairment.

195 Targeting Thalamocortical Circuits For Closed-Loop Stimulation in Lennox-Gastaut Syndrome

INTRODUCTION: Lennox-Gastaut syndrome (LGS) is a severe, childhood-onset epilepsy associated with frequent seizures, cognitive impairment, and high burden of care. Electrical stimulation of the thalamus can be an effective treatment for LGS, but complete seizure control is rarely achieved. Outcomes may be improved by stimulating areas beyond the thalamus, including cortex, but the optimal targets are unknown. METHODS: Brain network maps from 3 group-level studies of LGS were averaged to define the area of peak overlap: combined electroencephalography-functional MRI (EEG-fMRI) of paroxysmal fast activity, [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) of hypometabolism, and structural connectivity associated with efficacy in a previous trial of deep brain stimulation. The resulting “hotspot” was used as a seed in a normative fMRI connectivity analysis to identify connected networks. Two patients underwent bilateral thalamocortical implantations guided by this hotspot. Simultaneous recordings from cortex and thalamus were analyzed for presence and synchrony of epileptiform activity. RESULTS: Peak overlap was in bilateral premotor cortex. Functional connectivity of this hotspot revealed a network of frontoparietal cortex resembling the diffuse abnormalities seen on EEG-fMRI and FDG-PET. Intracranial electrophysiology showed characteristic epileptiform activity of LGS in the cortical hotspot that preceded or co-occurred with similar thalamic activity. CONCLUSIONS: Premotor cortex shows peak involvement in LGS, and functional connectivity of this region resembles the wider epileptic brain network. Thus, it may be an optimal target for neuromodulation therapies, including thalamocortical stimulation. Compared to thalamus-only stimulation, addition of this cortical target may allow more rapid detections and responsive stimulations of seizures, and broader modulation of the brain network underlying LGS to achieve greater seizure control.

Screening of Cognitive Impairment in patients with Rheumatoid arthritis

AbstractBackgroundRheumatoid arthritis (RA) is a chronic inflammatory disease that affects 0.5‐1% of the population, mainly women and older adults. There is increasing evidence of the presence of cognitive impairment in patients with RA, with a prevalence of around 30%. Some underlying mechanisms involved could be inflammation within the brain, high cardiovascular comorbidity, and the use of immunosuppressive agents that can be neurotoxic with prolonged use, among others. The Montreal Cognitive Assessment (MoCA) is a validated tool for detecting cognitive impairment in our country. The objective of this study is to determine the frequency of cognitive impairment in patients with RA compared to a group of patients with osteoarthritis.MethodWe assessed adult patients diagnosed with RA (2010 ACR/EULAR criteria) and osteoarthritis (ACR criteria) according to selection criteria. Demographic and clinical data were collected. The MoCA test was administered to all patients considering the cut‐off value <26 points to define the presence of cognitive impairment. The study was approved by the institutional ethics and research committee.ResultA total of 60 patients were included: 40 with RA (G1) and 20 with osteoarthritis (G2), the majority being women in both groups, mean age was 66.9 (SD 11.7) years and 71.4 (SD 10.6) years, respectively. There were no statistically significant differences in education, socioeconomic status, or vascular risk factors among groups. The frequency of cognitive impairment was significantly higher in G1 compared to G2: 42.5% (95% CI 28‐58.5) versus 15% (95% CI 4‐40)(p 0.026). Regarding MoCA domains, attention and memory were more affected in G1 compared to G2. In the multivariate analysis, the diagnosis of RA and older age were factors significantly associated with cognitive impairment.ConclusionIn our RA population, the frequency of cognitive impairment was 42.5%. RA diagnosis and older age were factors related to cognitive impairment. A substantial number of patients and the administration of a standard neuropsychological test will help us to validate these results.

The Spectrum of Cognitive Dysfunction in Amyotrophic Lateral Sclerosis: An Update.

Cognitive dysfunction is an important non-motor symptom in amyotrophic lateral sclerosis (ALS) that has a negative impact on survival and caregiver burden. It shows a wide spectrum ranging from subjective cognitive decline to frontotemporal dementia (FTD) and covers various cognitive domains, mainly executive/attention, language and verbal memory deficits. The frequency of cognitive impairment across the different ALS phenotypes ranges from 30% to 75%, with up to 45% fulfilling the criteria of FTD. Significant genetic, clinical, and pathological heterogeneity reflects deficits in various cognitive domains. Modern neuroimaging studies revealed frontotemporal degeneration and widespread involvement of limbic and white matter systems, with hypometabolism of the relevant areas. Morphological substrates are frontotemporal and hippocampal atrophy with synaptic loss, associated with TDP-43 and other co-pathologies, including tau deposition. Widespread functional disruptions of motor and extramotor networks, as well as of frontoparietal, frontostriatal and other connectivities, are markers for cognitive deficits in ALS. Cognitive reserve may moderate the effect of brain damage but is not protective against cognitive decline. The natural history of cognitive dysfunction in ALS and its relationship to FTD are not fully understood, although there is an overlap between the ALS variants and ALS-related frontotemporal syndromes, suggesting a differential vulnerability of motor and non-motor networks. An assessment of risks or the early detection of brain connectivity signatures before structural changes may be helpful in investigating the pathophysiological mechanisms of cognitive impairment in ALS, which might even serve as novel targets for effective disease-modifying therapies.

Perbedaan Kejadian Penurunan Fungsi Kognitif pada Individu Normotensi dan Hipertensi dari Populasi Pesisir di Kecamatan Pemenang Kabupaten Lombok Utara

Hypertension occurs due to vasoconstriction and impaired vasodilation which causes increased vascular resistance. Hypertension is the risk factor of Cognitive impairment decreased cognitive function through the mechanism of vascular damage and toxicity. Cognitive function is a complex function in the human brain. Cognitive impairment is also influenced by age, gender, physical activity, health factors, and education. The purpose of this study was to measure the effect of blood pressure on cognitive impairment in coastal populations in the working area of ​​the Pemenang Health Center, North Lombok Regency. The research method used a cross sectional approach. The sampling method was purposive sampling. Measurement of cognitive function status using the Clock Drawing Test (CDT) questionnaire. Univariate data analysis to determine the frequency distribution of variables; BMI, age, gender, educational, and occupation of respondents. Test the hypothesis using the Chi-Square test, with a probability value (p) <0.05. The total number of respondents were 188, in the hypertension group was 88 (47%) and the normotensive group was 100 (53%) respondents. The age of the dominant respondent is in the range of 36-45 years, namely 96 (51.1%). As many as 158 (84%) of respondents experienced cognitive impairment and 82 (43.6%) of them had hypertension. There was a significant difference in the incidence of cognitive impairment in the hypertension and normotensive groups (p=0.001). There was a difference in the frequency of cognitive impairment in normotensive and hypertensive respondents in coastal populations in the working area of ​​the Pemenang Health Center, North Lombok Regency.

Perbedaan Kejadian Penurunan Fungsi Kognitif pada Individu Normotensi dan Hipertensi dari Populasi Pesisir di Kecamatan Pemenang Kabupaten Lombok Utara

Hypertension occurs due to vasoconstriction and impaired vasodilation which causes increased vascular resistance. Hypertension is the risk factor of Cognitive impairment decreased cognitive function through the mechanism of vascular damage and toxicity. Cognitive function is a complex function in the human brain including aspects of memory, language, attention, visuospatial, and orientation. Cognitive impairment is also influenced by age, gender, physical activity, health factors, and education. The purpose of this study was to measure the effect of blood pressure on cognitive impairment in coastal populations in the working area of the Pemenang Health Center, North Lombok Regency. The research method used a cross sectional approach. The sampling method was purposive sampling. Measurement of cognitive function status using the Clock Drawing Test (CDT) questionnaire. Univariate data analysis to determine the frequency distribution of BMI research variables and the characteristics of respondents based on age, gender, educational, and occupation. Test the hypothesis using the Chi-Square test, with a probability value (p) <0.05. The total number of respondents were 188, in the hypertension group was 88 (47%) and the normotensive group was 100 (53%) respondents. The age of the dominant respondent is in the range of 36-45 years, namely 96 (51.1%). As many as 158 (84%) of respondents experienced cognitive impairment and 82 (43.6%) of them had hypertension. There was a significant difference in the incidence of cognitive impairment in the hypertension and normotensive groups (p=0.001). There was a difference in the frequency of cognitive impairment in normotensive and hypertensive respondents in coastal populations in the working area of the Pemenang Health Center, North Lombok Regency.

Frequency, pattern and predictors of cognitive impairments in patients with Parkinson's disease using the Community Screening Instrument for Dementia.

Parkinson's disease (PD) is a chronic neurodegenerative disorder complicated by cognitive dysfunctions which are associated with increased caregiver burden, pressure on community health facilities, and mortality in affected patients. Most of the data concerning cognitive dysfunctions in PD are from studies conducted in Europe and North America, but there is paucity of data from Sub-Saharan Africa. The objective of this study is to determine the frequency, pattern and predictors of cognitive impairments amongst patients with Parkinson's disease. This was a cross sectional case control study carried out at a tertiary health facility in South-south Nigeria. Participants with PD were consecutively recruited from the neurology outpatient clinics. Demographic and disease-specific data were obtained with the use of a pre-tested questionnaire. Cognitive performance of thirty patients with PD were compared with thirty demographically matched controls using the Community Screening Instrument for Dementia (CSID). CSID was already validated among Nigerians. The frequency of cognitive impairment using the CSID was 50% for PD patients (3.3% for controls). Poor cognitive performance was observed across several cognitive domains including language, executive dysfunction, psychomotor speed, and constructional apraxia among PD patients. The independent predictors of the overall cognitive impairment in patients with PD determined by logistic regression analysis include recall deficiency (p = 0.007), impairment with naming (p = 0.044), apraxia (p = 0.003), Hoen&Yahr staging (p = 0.046), UPDRS score (p = 0.015) and age at presentation (p = 0.014). Cognitive impairments occur more frequently in patients with PD compared to controls. This study also demonstrated the predictive role of severity of disease based on Hoehn &Yahr staging and UPDRS score, and presence of recall deficiency, poor naming ability and apraxia.

Multidisciplinary Center Care for Long COVID Syndrome–A Retrospective Cohort Study

BackgroundPersistent multi-organ symptoms after coronavirus disease 2019 (COVID-19) have been termed “long COVID” or “post-acute sequelae of SARS-CoV-2 infection.” The complexity of these clinical manifestations posed challenges early in the pandemic as different ambulatory models formed out of necessity to manage the influx of patients. Little is known about the characteristics and outcomes of patients seeking care at multidisciplinary post-COVID centers. MethodsWe performed a retrospective cohort study of patients evaluated at our multidisciplinary comprehensive COVID-19 center in Chicago, Ill, between May 2020 and February 2022. We analyzed specialty clinic utilization and clinical test results according to severity of acute COVID-19. ResultsWe evaluated 1802 patients a median of 8 months from acute COVID-19 onset, including 350 post-hospitalization and 1452 non-hospitalized patients. Patients were seen in 2361 initial visits in 12 specialty clinics, with 1151 (48.8%) in neurology, 591 (25%) in pulmonology, and 284 (12%) in cardiology. Among the patients tested, 742/916 (81%) reported decreased quality of life, 284/553 (51%) had cognitive impairment, 195/434 (44.9%) had alteration of lung function, 249/299 (83.3%) had abnormal computed tomography chest scans, and 14/116 (12.1%) had elevated heart rate on rhythm monitoring. Frequency of cognitive impairment and pulmonary dysfunction was associated with severity of acute COVID-19. Non-hospitalized patients with positive SARS-CoV-2 testing had findings similar to those with negative or no test results. ConclusionsThe experience at our multidisciplinary comprehensive COVID-19 center shows common utilization of multiple specialists by long COVID patients, who harbor frequent neurologic, pulmonary, and cardiologic abnormalities. Differences in post-hospitalization and non-hospitalized groups suggest distinct pathogenic mechanisms of long COVID in these populations.

Cognitive and MRI Profiles in Primary and Secondary Progressive Multiple Sclerosis (P13-3.002)

<h3>Objective:</h3> We examined the neuropsychological profile of primary progressive (PP) and secondary progressive (SP) multiple sclerosis (MS) patients and investigated the relationship between cognitive functioning with structural and functional MRI abnormalities. <h3>Background:</h3> Studies comparing frequency and patterns of cognitive dysfunction between PPMS and SPMS have yielded conflicting results. <h3>Design/Methods:</h3> One-hundred eighty-three MS patients (60 PPMS and 123 SPMS) and 75 age- and sex-matched healthy controls underwent 3.0T MRI. MS patients were administered the Brief Repeatable Battery of Neuropsychological tests (BRB-N) and were classified as cognitively impaired if they scored below the 5^th percentile of the normative sample on at least two tests. Four cognitive domain z-scores were determined from normative data, and then averaged to obtain a measure of global cognition (z-BRB-N). Using hierarchical linear regression analysis, the contribution of lesion volumes, normalized brain volumes, white matter fractional anisotropy (FA) and mean diffusivity (MD) abnormalities, and resting state (RS) functional connectivity (FC) alterations to global cognition in PPMS and SPMS was investigated. <h3>Results:</h3> Patients with PPMS and SPMS had similar z-scores in all investigated cognitive domains. Compared to PPMS, SPMS showed decreased FA and increased MD in the fornix, and lower RS FC within the basal ganglia network. The frequency of cognitive impairment was 31.7% in PPMS and 41.3% in SPMS (p=0.19). In PPMS, poorer cognitive performance (e.g., lower z-BRB-N) was associated with decreased FA of the medial lemniscus (ΔR²=0.11; p=0.011) and lower normalized gray matter volume (ΔR²=0.29; p&lt;0.001). In SPMS, poorer cognitive performance was associated with decreased FA of the fornix (ΔR²=0.35; p&lt;0.001) and lower normalized white matter volume (ΔR²=0.05; p=0.034). <h3>Conclusions:</h3> PPMS and SPMS had similar neuropsychological profile. Cognitive dysfunction in PPMS and SPMS was related to distinct patterns of structural MRI abnormalities and involvement of different white matter tracts, while RS FC alterations did not contribute to explain their global cognitive functioning. <b>Disclosure:</b> Damiano Mistri has nothing to disclose. Ms. Cacciaguerra has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Ms. Cacciaguerra has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS Celgene. Ms. Cacciaguerra has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Ms. Cacciaguerra has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BIOMEDIA. Paola Valsasina has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for ACCMED. Elisabetta Pagani has nothing to disclose. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers Squibb . Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi Genzyme. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Bristol Myers Squibb, Celgene, Genzyme, Merck Serono, Novartis, Roche, and Teva. The institution of Maria Assunta Rocca has received research support from Italian Ministry of Health, MS Society of Canada and Fondazione Italiana Sclerosi Multipla. Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bayer, Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, Takeda, and Teva Pharmaceutical Industries. Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Bayer, Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, Takeda, and Teva Pharmaceutical Industries. Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, Teva Pharmaceutical Industries, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA).

Risk factors of cognitive impairment post-ischemic stroke

BackgroundStroke is still remarked as one of the major ailments in Indonesia. Cognitive impairment occurs frequently after stroke events and its predictors are needed to identify patients with a high risk of cognitive impairment. However, the researches done in Indonesia still vary in results. This retrospective cohort study evaluated 236 ischemic stroke patients in Bethesda Hospital Yogyakarta from January–November 2020 through medical records. Cognitive impairment was measured by MMSE and CDT, defined as MMSE score le 20 for patients with the educational attainment of 1–6 years; le 24 for the educational attainment of > 6 years and/ or CDT < 4. All data were analyzed with univariate test and Chi-square test, followed by logistic regression.ResultsOf 236 subjects, the frequency of cognitive impairment was 67.4% and the risk factors are age > 80 years old (RR: 1,545; CI 0.136–17.542; p: 0.026), educational attainment ≤ 6 years (RR: 20.016; CI 1.951–222.120; p: 0.012), temporal (RR: 4.238; CI 2.266–7.926; p: 0.007) or multiple site lesion location (RR: 7.522; CI: 3.522–17.532; p: 0.047) and multiple (> 1) lesions (RR: 1,819; CI 0.822–4.022; p: 0.040).ConclusionsThe prevalence of post-stroke cognitive impairment is high, affecting up to 2 out of 3 people in this study. The risk factors of post-stroke cognitive impairment are age > 80 years, educational attainment le 6 years, temporal or multiple site lesion, and > 1 lesion. Strict stroke prevention strategies are needed to halt the development of post-stroke cognitive impairment.

Neurocognitive Deficits in First-Episode and Chronic Psychotic Disorders: A Systematic Review from 2009 to 2022.

Cognitive impairment in patients suffering from schizophrenia spectrum disorders has been discussed as a strong predictor for multiple disease outcome variables, such as response to psychotherapy, stable relationships, employment, and longevity. However, the consistency and severity of cognitive deficits across multiple domains in individuals with first-episode and chronic psychotic disorders is still undetermined. We provide a comprehensive overview of primary research from the years 2009 to 2022. Based on a Cochrane risk assessment, a systematic synthesis of 51 out of 3669 original studies was performed. Impairment of cognitive functioning in patients diagnosed with first-episode psychotic disorders compared with healthy controls was predicted to occur in all assessed cognitive domains. Few overall changes were predicted for chronically affected patients relative to those in the first-episode stage, in line with previous longitudinal studies. Our research outcomes support the hypothesis of a global decrease in cognitive functioning in patients diagnosed with psychotic disorders, i.e., the occurrence of cognitive deficits in multiple cognitive domains including executive functioning, memory, working memory, psychomotor speed, and attention. Only mild increases in the frequency of cognitive impairment across studies were observed at the chronically affected stage relative to the first-episode stage. Our results confirm and extend the outcomes from prior reviews and meta-analyses. Recommendations for psychotherapeutic interventions are provided, considering the broad cognitive impairment already observed at the stage of the first episode. Based on the risk of bias assessment, we also make specific suggestions concerning the quality of future original studies.

Frequency of cognitive impairment in older forensic inpatients: results of a pilot cross-sectional study

ABSTRACT The number of older inpatients in forensic hospitals is growing. Overall, complex needs in treatment are identified for this group, and differ significantly from those of younger forensic patients. To date, there has been little awareness of the relevance of age-related changes in cognitive function of older forensic patients. Data on the prevalence of cognitive disorders in older forensic inpatients are rare, and, for German forensic hospitals, completely lacking. Against this background, a pilot project was conducted in forensic departments of five Psychiatric hospitals in North Rhine Westphalia, Germany. Sociodemographics, crime-related characteristics and medical data of inpatients aged 60 years and older were collected. Established cognitive screening instruments were administered. 34 of 134 forensic patients aged 60–91 years participated in the study. Dependent on the instrument used, up to 65% showed impairment in global cognitive functioning and up to 68% showed executive dysfunctions. Our pilot data indicate that cognitive impairment in older forensic patients in Germany is more frequent than reported for the older general population in Germany. Based on the findings, the extent to which diagnostic routines should be implemented and the complex factors (e.g. the underlying mental illness) that need to be taken into account are discussed.

Cognitive profile of patients with and without speech impairment in Parkinson's disease.

To compare the groups of patients with and without speech disorders with cognitive assessment, demographic, and clinical data (disease duration, functionality, and motor symptoms). Retrospective, cross-sectional study. Patients were evaluated using the Addenbrooke's Cognitive Examination III and neuropsychological tests. The following speech subsystems were analyzed: articulation, phonation, resonance, and prosody, through auditory-perceptual evaluation (based on the Protocol for the Evaluation of Acquired Speech Disorders in Individuals with Parkinson's Disease - PADAF Protocol tests), observing aspects of speech programming and execution. The patients were distributed into three subgroups (normal cognition, mild cognitive impairment, and dementia). After speech evaluation, they were divided into two subgroups (with and without speech disorders). A total of 150 patients participated in this study, 104 men and 46 women, 63.58 (8.81) years of age, 11.03 (4.00) years of schooling, 6.61 (4.69) years of disease progression, and with the highest proportion of individuals in stage I-II of the Hoehn & Yarh (H&Y) scale (86, or 57.33%). Statistically significant differences were observed between subgroups with and without speech alteration. Worse performance was verified in the Trail Making Test (TMT) TMT-Δ and a tendency of difference in the TMT-B of the subgroup with speech disorders, in addition to worse severity of motor symptoms (H&Y) and cognitive complaints. Individuals with speech disorders brought more frequent cognitive complaints and impairment below expected in tests assessing executive functions. Future studies, with stratification by type of speech disorder, are necessary to contribute to and validate these results.

Cognitive dysfunction associated with COVID-19: Prognostic role of circulating biomarkers and microRNAs.

COVID-19 is renowned as a multi-organ disease having subacute and long-term effects with a broad spectrum of clinical manifestations. The evolving scientific and clinical evidence demonstrates that the frequency of cognitive impairment after COVID-19 is high and it is crucial to explore more clinical research and implement proper diagnostic and treatment strategies. Several central nervous system complications have been reported as comorbidities of COVID-19. The changes in cognitive function associated with neurodegenerative diseases develop slowly over time and are only diagnosed at an already advanced stage of molecular pathology. Hence, understanding the common links between COVID-19 and neurodegenerative diseases will broaden our knowledge and help in strategizing prognostic and therapeutic approaches. The present review focuses on the diverse neurodegenerative changes associated with COVID-19 and will highlight the importance of major circulating biomarkers and microRNAs (miRNAs) associated with the disease progression and severity. The literature analysis showed that major proteins associated with central nervous system function, such as Glial fibrillary acidic protein, neurofilament light chain, p-tau 181, Ubiquitin C-terminal hydrolase L1, S100 calcium-binding protein B, Neuron-specific enolase and various inflammatory cytokines, were significantly altered in COVID-19 patients. Furthermore, among various miRNAs that are having pivotal roles in various neurodegenerative diseases, miR-146a, miR-155, Let-7b, miR-31, miR-16 and miR-21 have shown significant dysregulation in COVID-19 patients. Thus the review consolidates the important findings from the numerous studies to unravel the underlying mechanism of neurological sequelae in COVID-19 and the possible association of circulatory biomarkers, which may serve as prognostic predictors and therapeutic targets in future research.

Twelve Months and Counting: Following Clinical Outcomes in Critical COVID-19 Survivors.

Rationale: Recent reports suggest that patients with severe coronavirus disease (COVID-19) often experience long-term consequences of the infection. However, studies on intensive care unit (ICU) survivors are underrepresented. Objectives: We aimed to explore 12-month clinical outcomes after critical COVID-19, describing the longitudinal progress of disabilities, frailty status, frequency of cognitive impairment, and clinical events (rehospitalization, institutionalization, and falls). Methods: We performed a prospective cohort study of survivors of COVID-19 ICU admissions in Sao Paulo, Brazil. We assessed patients every 3 months for 1 year after hospital discharge and obtained information on 15 activities of daily living (basic, instrumental, and mobility activities), frailty, cognition, and clinical events. Results: We included 428 patients (mean age of 64 yr, 61% required invasive mechanical ventilation during ICU stay). The number of disabilities peaked at 3 months compared with the pre-COVID-19 period (mean difference, 2.46; 99% confidence interval, 1.94-2.99) and then decreased at 12 months (mean difference, 0.67; 99% confidence interval, 0.28-1.07). At 12-month follow-up, 12% of patients were frail, but half of them presented frailty only after COVID-19. The prevalence of cognitive symptoms was 17% at 3 months and progressively decreased to 12.1% (P = 0.012 for trend) at the end of 1 year. Clinical events occurred in all assessments. Conclusions: Although a higher burden of disabilities and cognitive symptoms occurred 3 months after hospital discharge of critical COVID-19 survivors, a significant improvement occurred during the 1-year follow-up. However, one-third of the patients remained in worse conditions than their pre-COVID-19 status.

A change of perspective? An explorative study on why patients may not subjectively report cognitive impairments after a cardiac arrest

AimCardiac arrest survivors are at risk of long-term cognitive impairment. Patients with cognitive impairments do not always have cognitive complaints and vice versa. Not reporting cognitive complaints could be caused by a lack of awareness. We hypothesized that caregivers report more cognitive failures than patients, indicating patients’ lack of insight into cognitive functioning. MethodsThis is a secondary analysis of the Activity and Life After Survival of Cardiac Arrest study on survivors of cardiac arrest and their caregivers. They were assessed at two weeks, three months, and one year after cardiac arrest. At each time point, the patient and the caregiver filled out the cognitive failure questionnaire (CFQ) regarding the patient. We analysed the correlation, intraclass correlation, and self-proxy discrepancy between patients and caregivers on the CFQ over time. ResultsOne-hundred-and-nineteen cardiac arrest survivors (mean age = 60, 85 % male) and their caregivers were included. The CFQ scores of the patients and caregivers were equally low. The correlation (T1 r = 0.31; T2 r = 0.40; T3 r = 0.55) and intraclass correlation (T1 r = 0.48; T2 r = 0.56; T3 r = 0.71) between patient and caregiver increased over time. ConclusionThis study does not support a lack of awareness of cognitive impairments by long-term cardiac arrest survivors. Future research may focus on alternative explanations for why patients have less cognitive complaints than expected based on the frequency of cognitive impairments. Possible explanations include a response shift.

Clearing the Fog: a Systematic Review on Cognitive Dysfunction in COVID-19

[Objective] The systematic review aims to examine the association between COVID-19 and cognitive dysfunction, including the link between the severity of COVID-19 and the occurrence of cognitive impairment and the potential pathophysiological mechanisms related to brain fog among COVID-19 patients. [Methods] PubMed, Oxford University Press, ProQuest Health and Medical Complete, ScienceDirect, Ovid, HERDIN, Google Scholar, and Cochrane Library databases were accessed to retrieve literature using the PRISMA guidelines. [Results] After critical appraisal, 13 full journal articles were included in the study. The studies showed the most frequent cognitive impairment are attention, memory, and executive function in COVID-19 patients. Compared with healthy controls in three out of four studies, cognitive impairment was only evident in COVID-19 patients. Furthermore, two studies showed no correlation between brain fog and depression, and five studies showed a link between the severity of COVID-19 infection and cognitive impairment. Cases ranging from mild to severe illness presented manifestations of brain fog. However, a disparity in the evidence of the pathophysiology of COVID-19 and cognitive dysfunction exists, prompting the need to investigate further. Additionally, recent studies provide insufficient evidence for direct central nervous system invasion, and there are emerging studies that contrast the presumed pathogenesis of neurological complications from neuroinflammation. [Conclusion] There is an association between COVID-19 and cognitive dysfunction. Manifestation of cognitive dysfunction is present regardless of illness severity. Moreover, there are existing pathophysiological mechanisms of the Coronavirus that lead to cognitive dysfunction in COVID-19 patients; however, additional studies are required to substantiate such mechanisms further. [PROSPERO registration number] CRD42022325669.

Motor and nonmotor symptoms in patients treated with 24-hour daily levodopa-carbidopa intestinal gel infusion: Analysis of the COmedication Study assessing Mono- and cOmbination therapy with levodopa-carbidopa inteStinal gel (COSMOS)

IntroductionPatients with advanced Parkinson's disease (APD) commonly experience motor and nonmotor symptoms (NMS) associated with functional limitations and decreased quality of life. We compared motor and nonmotor outcomes in patients with APD receiving 24- versus 16-h levodopa-carbidopa intestinal gel (LCIG). MethodsData from COSMOS, a large, real-world, retrospective and cross-sectional, observational study on LCIG and comedication in APD were obtained from medical records and a single patient visit for patients receiving 24- and 16-h LCIG infusion. Changes from baseline were evaluated for motor symptoms, NMS, and clinical characteristics. Safety was also assessed. ResultsData for 401 patients were included in this subanalysis. At the patient visit there were 35 patients on 24-h LCIG and 366 on 16-h LCIG. “Off” time and dyskinesia (duration and severity) were reduced in both groups. In both LCIG treatment groups, prevalence of most symptoms was reduced. There were significant differences in the change from baseline in severity and frequency of freezing of gait with 24-h LCIG versus 16-h LCIG (p = 0.011 and p = 0.038), severity of urinary symptoms (p = 0.006), and frequency of cognitive impairment (p = 0.014) with 24-h LCIG versus 16-h LCIG. Adverse events were similar for both treatment groups and considered tolerable. ConclusionsLCIG 24-h infusion may be a useful treatment option, when clinically justified, for select patients with APD. Clinical trial numberNCT03362879.

The Frequency and Pattern of Cognitive Impairment in the Elderly at the Out Patients Clinic of The Holy Family Hospital, Techiman, Ghana

Background: Ghana’s elderly population increased by 367 percent from 1960 to the year 2000. There have been few studies on cognitive impairment amongst elderly patients in Ghana.Aim: This study was conducted to determine the frequency and pattern of cognitive impairment in the elderly at the outpatients’ clinic of the Holy Family Hospital, Techiman, Ghana.Methods: The study was a descriptive cross-sectional study. Cognitive impairment was assessed using modified versions of test your memory test, 10 word recall test, trail making test part B and the mini mental state exam. The effect of cognitive impairment on dailyactivities was assessed using the activities of daily living scale. Multiple regression analysis was done to determine factors associated with the various cognitive tests chosen.Results: Forty-nine (49) percent of respondents had cognitive impairment using the Ten (10) word list recall whereas 72% of the respondents had cognitive impairment on the modified Test your memory test. On the Mini mental state exam, 76% of respondents had cognitive impairment. Six percent of respondents had cognitive impairment on the Trail making test B. The cognitive domains most affected were visuospatial skills, semantic knowledge, arithmetic and attention. The least affected cognitive domains were verbalfluency, ability to copy, calculation, verbal recall and orientation. A higher educational level was associated with higher scores on all the cognitive tests chosen (p&lt; 0.003).Conclusion: It can be concluded that the frequency of cognitive impairment amongst elderly patients in Techiman is high with visuospatial skills, semantic knowledge, arithmetic and attention being the most affected cognitive domains.

Cognitive Performance and Health-Related Quality of Life in Patients with Neuromyelitis Optica Spectrum Disorder.

Background: The frequency of cognitive impairment (CI) reported in neuromyelitis optica spectrum disorder (NMOSD) is highly variable, and its relationship with demographic and clinical characteristics is poorly understood. We aimed to describe the cognitive profile of NMOSD patients, and to analyse the cognitive differences according to their serostatus; furthermore, we aimed to assess the relationship between cognition, demographic and clinical characteristics, and other aspects linked to health-related quality of life (HRQoL). Methods: This cross-sectional study included 41 patients (median age, 44 years; 85% women) from 13 Spanish centres. Demographic and clinical characteristics were collected along with a cognitive z-score (Rao’s Battery) and HRQoL patient-centred measures, and their relationship was explored using linear regression. We used the Akaike information criterion to model which characteristics were associated with cognition. Results: Fourteen patients (34%) had CI, and the most affected cognitive domain was visual memory. Cognition was similar in AQP4-IgG-positive and -negative patients. Gender, mood, fatigue, satisfaction with life, and perception of stigma were associated with cognitive performance (adjusted R2 = 0.396, p < 0.001). Conclusions: The results highlight the presence of CI and its impact on HRQoL in NMOSD patients. Cognitive and psychological assessments may be crucial to achieve a holistic approach in patient care.