Frontal Assessment Battery Scores Research Articles

Prediction of Treatment Response and Effect on Clinical Manifestations for Normal Pressure Hydrocephalus of Sleep Related Breathing Disorders

Objectives: Sleep disorders and normal pressure hydrocephalus (NPH) are increasingly important issues observed in neurological disorders. However, the correlation between these diseases has not been sufficiently studied. Thus, we discuss the correlation between sleep disorders and the clinical features of NPH. Methods: Overall, 40 patients with idiopathic NPH were included in the study. To evaluate the sleep disorders and psychiatric problems, surveys were administered, including the 36-Item Short Form Survey, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Berlin Questionnaire, STOP-Bang Questionnaire, Hospital Anxiety and Depression Scale (HADS), Morningness-Eveningness Questionnaire, and the REM Sleep Behavior Disorder Screening Questionnaire. To evaluate the severity of dementia and ataxia, all of the patients completed the Korean mini-mental state examination; Korea frontal assessment battery score, amd unified Parkinson’s disease rating scale-motor scores before and after cerebrospinal fluid (CSF) drainage. The Pearson’s chi-square test, independent Student’s t-test, Mann–Whitney U test, and linear regression analysis were used to analyze the relationship between sleep disorders and symptom improvement after CSF drainage. Results: Of the 40 patients, 21 patients had poor sleep quality (PSQI>5), 8 patients had insomnia (ISI≥8), 11 patients had daytime sleepiness (ESS≥11), 9 (STOP-Bang≥3) to 13 (Berlin≥2 categories) patients had sleep apnea, 13 patients were anxious (HAS≥8), and 27 patients were depressed (HDS≥8). A linear regression analysis showed that sleep apnea was significantly correlated with cognitive function, and insomnia was correlated with cognitive, motor, and frontal lobe functions. Additionally, patients with severe sleep apnea demonstrated a greater recovery of cognitive function after CSF drainage. Conclusions: Obstructive sleep apnea (OSA) is closely related to the clinical symptoms and treatment effectiveness of NPH. The diagnosis and proper treatment of OSA is expected to improve the prognosis of patients with NPH.

Noise Pareidolia Test in Parkinson's Disease and Atypical Parkinsonian Syndromes: A Retrospective Study.

Pareidolias, or visual misperceptions, are a non-motor symptom of Parkinson's disease (PD) with unclear pathophysiology. The noise pareidolia test (NPT) is a tool for screening pareidolias. The usefulness of the NPT in differentiating PD from atypical parkinsonian syndromes (APS) is also unknown. We retrospectively investigated 74 patients with PD and 18 patients with APS who took the NPT. Correlations between the number of pareidolic responses, gray matter volume, and cerebral blood flow were also examined in the patients with PD. The median number of pareidolic responses in patients with PD and patients with APS was 0 (interquartile range (IQR): 0-3) and 0 (IQR: 0-1), respectively, and tended to be higher in patients with PD than in those with APS (p = 0.077). It was significantly higher in patients with PD who had hallucinations (2; IQR: 0-9) (p = 0.016). The area under the receiver operating characteristic curve for the number of pareidolic responses in the NPT was 0.62 when used to differentiate PD and APS, and the optimal cutoff number of pareidolic responses was 2/3. Sensitivity and specificity were 25.7% and 100%, respectively. In the PD group, the number of pareidolic responses was correlated with age (r = 0.27; p = 0.021) and the Frontal Assessment Battery (FAB) score (r = -0.34; p = 0.0099). Magnetic resonance imaging showed no significant correlation between the number of pareidolic responses and the volume of focal gray matter. On cerebral hypoperfusion mapping, the left parietal lobe had a significant correlation with the number of pareidolic responses (r = 0.35; p = 0.027). The number of pareidolic responses in NPT was suggested to be useful as a red flag to rule out APS in differentiating PD from APS. In PD without dementia, the number of pareidolic responses was associated with reduced blood flow in the left parietal lobe.

Irreversible postoperative cognitive impairment after unruptured intracranial aneurysm treatment in the elderly.

Postoperative cognitive dysfunction and recovery remain unclear in older patients undergoing interventional therapies for unruptured intracranial aneurysms (UIAs). This study aimed to compare changes in postoperative cognitive function between younger and older patients and to detect factors associated with non-recovery from postoperative cognitive dysfunction. This study reviewed 59 consecutive patients with UIAs who underwent interventional therapies, including microsurgical clipping or endovascular treatment, from 2021 to 2022. All patients were divided into the older (aged ≥ 70years) and younger (aged < 70years) groups. Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) were performed within 2months before interventions, at 1week postoperatively (POW1), and 3-6months postoperatively (POM3-6). MMSE and FAB scores decreased more frequently in the older group than in the younger group at POW1 (older vs. younger: MMSE: 48% vs. 21%, p < 0.05; FAB: 56% vs. 18%, p < 0.01). In the older group, the FAB Z-score decreased in POW1 and recovered by POM3-6 (p < 0.01), while the MMSE Z-score continued to decrease (p = 0.04). Age and the preoperative MSME Z-score were significantly associated with non-recovery from decreased MMSE score at POM3-6 (recovery vs. non-recovery, age: 62years old vs. 72years old, p = 0.03, preoperative MMSE Z-score: 0.16 vs. - 0.90, p < 0.01). This retrospective study found that older patients were more likely to have a postoperative cognitive decline after UIA treatment and implicated that global cognitive function tended to decline more than executive function in the long term. In addition, this study demonstrated that lower preoperative cognitive function was associated with inadequate postoperative cognitive recovery. The findings potentially contribute to the establishment of indications for treating UIAs in older patients.

Efficacy of dual-task augmented reality rehabilitation in non-hospitalized adults with self-reported long COVID fatigue and cognitive impairment: a pilot study.

Cognitive impairment and chronic fatigue represent common characteristics of the long COVID syndrome. Different non-pharmacological treatments have been proposed, and physiotherapy has been proposed to improve the symptoms. This study aimed to evaluate the effects of a dual-task augmented reality rehabilitation protocol in people with long COVID fatigue and cognitive impairment. Ten non-hospitalized adults with reported fatigue and "brain fog" symptoms after COVID (7/10 females, 50years, range 41-58) who participated in 20 sessions of a 1-h "dual-task" training, were compared to 10 long COVID individuals with similar demographics and symptoms (9/10 females, 56years, range 43-65), who did not participate to any rehabilitation protocol. Cognitive performance was assessed with the Trail Making Test (TMT-A and -B) and Frontal Assessment Battery (FAB), and cardiovascular and muscular fatigue were assessed with the fatigue severity scale (FSS), six-minute walking test and handgrip endurance. Finally, transcranial magnetic stimulation (TMS) investigated cortical excitability. The mixed-factors analysis of variance found a significant interaction effect only in cognitive performance evaluation, suggesting TMT-B execution time decreased (- 15.9s, 95% CI 7.6-24.1, P = 0.001) and FAB score improved (1.88, 95% CI 2.93-0.82, P = 0.002) only in the physiotherapy group. For the remaining outcomes, no interaction effect was found, and most parameters similarly improved in the two groups. The preliminary resultsfrom this study suggest that dual-task rehabilitation could be a feasible protocol to support cognitive symptoms recovery afterCOVID-19 and could be helpful in those individuals suffering from persisting and invalidating symptoms.

Facial emotion recognition is associated with executive functions and depression scores, but not staging of dementia, in mild-to-moderate Alzheimer's disease.

Although deficits in facial emotion recognition (FER) significantly affect interpersonal communication and social functioning, there is no consensus on how FER affects Alzheimer's disease (AD). In this study, we aimed to investigate the clinical and neuropsychological factors affecting the possible deficits in the FER abilities of patients with AD. This cross-sectional study included 37 patients with mild [clinical dementia rating (CDR) scale score=1] or moderate (CDR=2) AD, in whom vascular dementia and depression were excluded, and 24 cognitively normal (CDR=0) subjects. FER ability was determined using the facial emotion identification test (FEIT) and facial emotion discrimination test (FEDT). All participants underwent mini-mental state examination (MMSE), frontal assessment battery (FAB), and geriatric depression scale (GDS). The neuropsychiatric inventory-clinician rating scale (NPI-C), Katz index of independence in activities of daily living, and Lawton instrumental activities of daily living were also administered to patients with AD. The FEIT and FEDT total scores showed that patients with mild and moderate AD had significant FER deficits compared to healthy controls. However, no significant difference was observed between patients with mild and moderate AD in the FEIT and FEDT total scores. FEIT and FEDT scores were not correlated with the MMSE and NPI-C total and subscales scores in patients with AD. Linear regression indicated that FEIT and FEDT total scores were significantly related to age and FAB scores. The GDS score negatively moderated the relationship between FAB and FEDT. This study demonstrated a decreased FER ability in patients with AD. The critical point in FER deficits is the presence of dementia, not the dementia stage, in AD. It has been determined that executive functions and depression (even at a subsyndromal level), which have limited knowledge, are associated with FER abilities.

Clinical and psychometric characteristics of cognitive and negative disorders in schizophrenia

To establish the characteristics of clinical manifestations and cognitive tests in patients with schizophrenia, with a predominance of cognitive and negative disorders. We examined 76 patients, 66 in the main group, 10 in the comparison group, who were treated in Psychiatric Hospital No. 1 and Psychiatric Hospital No. 4 (Moscow). Clinical-psychopathological, psychometric and statistical methods were used. Features of cognitive functioning were studied using the Frontal Assessment Battery (FAB) and the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis (ALS) Screen (ECAS). Emotional intelligence scores were assessed using the Ekman Face Emotion Recognition (EFER) test. Patients with schizophrenia showed dominance of one of 3 types of deficit symptoms: cognitive, emotional, and volitional. Cognitive functions were significantly reduced in patients with schizophrenia when compared with the comparison group (mean FAB score (M±SD) 13.44±2.97 in patients with schizophrenia vs. 16.10±1.70 in the comparison group; t=4.10; p<0.001). Cognitive functions were particularly reduced in patients with volitional deficit (mean EFER total score 42.40±9.0 in patients with volitional deficit vs. 47.21±633 in patients with cognitive deficit; t=2.12; p=0.039; mean FAB score 12.83±3.29 in patients with volitional deficit vs. 16.10±1.70 in the comparison group; t=4.24; p<0.001; mean ECAS score specific to ALS 78.80±9.07 in patients with volitional deficit vs. 84.50±6.71 in the comparison group; t=2.18; p=0.034). The greatest contribution to the development of cognitive disorders in schizophrenia is made by dysfunction of frontal (especially) and temporal cortex. Executive functions, speech skills and verbal fluency are most severely damaged.

Predictive Ability of Frontal Assessment Battery for Cognitive Improvement After Shunt Surgery in Individuals With Idiopathic Normal Pressure Hydrocephalus.

The predictive ability of the Frontal Assessment Battery (FAB) for postoperative cognitive improvement in idiopathic normal pressure hydrocephalus (iNPH) is unstudied. To compare the predictive ability of the FAB and the Mini-Mental State Examination (MMSE) for postoperative cognitive improvement in individuals with iNPH after shunt surgery. We retrospectively reviewed the medical records of individuals with iNPH who had shunt surgery between January 2016 and October 2018. Individuals had completed the tap test and clinical evaluations (FAB, MMSE, Timed Up and Go [TUG]) both before and 24-48 hours after CSF tapping and after surgery. We excluded individuals without complete clinical evaluations and those with shunt surgery performed >6 months after CSF tapping. Factors associated with postoperative FAB and MMSE improvement as per the 2011 iNPH guidelines were extracted using univariate and multivariate logistic regression analyses. Independent variables were baseline FAB and MMSE scores, FAB and MMSE score changes and TUG amelioration rate after CSF tapping, Evans index, age, and days from CSF tapping to surgery and from surgery to postoperative assessment. The mean number of days from CSF tapping to surgery and from surgery to postoperative assessment were 77.5 (SD = 36.0) and 42.0 (SD = 14.5), respectively. Logistic regression analyses showed significant associations in the univariate analyses of postoperative FAB improvement with baseline FAB scores ( P = 0.043) and with FAB score changes after CSF tapping ( P = 0.047). The FAB may help predict postoperative cognitive improvement after shunt surgery better than the MMSE.

P135: Electroencephalography-Based Neuro-emotional Responses during interactive scenario therapy in the person with dementia – case study

Background:Immersive technologies have the potential to control cognitive and behavioural symptoms in people with dementia. A safe environment can be designed through a specific interactive scenario, according to the preferences and experiences of each user.Objective:Mapping neuro-emotional responses during the interactive scenario therapy experience in a case study, with dementia, using electroencephalography (EEG).Methods:A participant, 78 years old and diagnosed with moderate to severe Alzheimer's disease (female; Mini Mental State Examination score of 17 points; frontal assessment battery score of 8 points), underwent EEG analysis (EMOTIV EPOC X) using a protocol with interactive scenarios tailored to the participant's needs and preferences, the scenarios were designed from reminiscence strategies. The protocol included a stimulus that alternated between motor and cognitive activities (3 minutes), and breath-centered relaxation (1 minute). The scenarios used in this study were: setting up a living room; composing a cake recipe; shopping in the market to make a cake; looking for objects in the park; organizing a birthday party. These variables are provided, on a scale of 0 to 100, after processing by the algorithms of the EmotivPRO v3.0 software.Results:The values found in the EEG analysis will be described without stimulus and with stimulus respectively. Thus, engagement (68.57 to 71.86); arousal (57.86 to 49.86), focus (61.57 to 57.00), interest (54.86 to 49.57), relaxation (33.86 to 30.86), and stress (53.71 to 43.00). The EEG data showed an increase in engagement when the patient was stimulated (68.57 to 71.86). Relaxation also increased (30.86 to 33.86) when the stimulus was removed. The stress level, as analysed by the EEG, was also higher in the period without stimulus and reduced in the period with the stimulus (53.71 to 43).Conclusion:During a stimulus period in interactive therapy, there was an increase in engagement, which was related to an increasing focus during the stimulus. Lower values were observed compared to the period without stimulus, indicating a period of recovery after a period of concentration/arousal. Therefore, therapy with an interactive and familiar scenario, using a circuit of stimulus-breathing exercises, promotes a positive and adequate neuro-emotional response in a person with dementia.

Plasma glial fibrillary acidic protein as a biomarker of disease progression in Parkinson’s disease: a prospective cohort study

BackgroundReactive astrogliosis has been demonstrated to have a role in Parkinson’s disease (PD); however, astrocyte-specific plasma glial fibrillary acidic protein (GFAP)’s correlation with PD progression remains unknown. We aimed to determine whether plasma GFAP can monitor and predict PD progression.MethodsA total of 184 patients with PD and 95 healthy controls (HCs) were included in this prospective cohort study and followed-up for 5 years. Plasma GFAP, amyloid-beta (Aβ), p-tau181, and neurofilament light chain (NfL) were measured at baseline and at 1- and 2-year follow-ups. Motor and non-motor symptoms, activities of daily living, global cognitive function, executive function, and disease stage were evaluated using the Unified Parkinson’s Disease Rating Scale (UPDRS) part III, UPDRS-I, UPDRS-II, Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), and Hoehn and Yahr (H&Y) scales at each visit, respectively.ResultsPlasma GFAP levels were higher in patients with PD (mean [SD]: 69.80 [36.18], pg/mL) compared to HCs (mean [SD]: 57.89 [23.54], pg/mL). Higher levels of GFAP were observed in female and older PD patients. The adjusted linear mixed-effects models showed that plasma GFAP levels were significantly associated with UPDRS-I scores (β: 0.006, 95% CI [0.001–0.011], p = 0.027). Higher baseline plasma GFAP correlated with faster increase in UPDRS-I (β: 0.237, 95% CI [0.055–0.419], p = 0.011) and UPDRS-III (β: 0.676, 95% CI [0.023–1.330], p = 0.043) scores and H&Y stage (β: 0.098, 95% CI [0.047–0.149], p < 0.001) and faster decrease in MoCA (β: − 0.501, 95% CI [− 0.768 to − 0.234], p < 0.001) and FAB scores (β: − 0.358, 95% CI [− 0.587 to − 0.129], p = 0.002). Higher baseline plasma GFAP predicted a more rapid progression to postural instability (hazard ratio: 1.009, 95% CI [1.001–1.017], p = 0.033).ConclusionsPlasma GFAP might be a potential biomarker for monitoring and predicting disease progression in PD.

Effects of carotid revascularization on cognitive function and brain functional connectivity in carotid stenosis patients with cognitive impairment: a pilot study.

Carotid stenosis can lead to both cognitive impairment (CI) and ischemic stroke. Although carotid revascularization surgery, which includes carotid endarterectomy (CEA) and carotid artery stenting (CAS), can prevent future strokes, its effect on cognitive function is controversial. In this study, the authors examined resting-state functional connectivity (FC) in carotid stenosis patients with CI undergoing revascularization surgery, with a particular focus on the default mode network (DMN). Twenty-seven patients with carotid stenosis who were scheduled to undergo CEA or CAS between April 2016 and December 2020 were prospectively enrolled. A cognitive assessment, including the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Japanese version of the Montreal Cognitive Assessment (MoCA), as well as resting-state functional MRI, was performed 1 week preoperatively and 3 months postoperatively. For FC analysis, a seed was placed in the region associated with the DMN. The patients were divided into two groups according to the preoperative MoCA score: a normal cognition (NC) group (MoCA score ≥ 26) and a CI group (MoCA score < 26). The difference in cognitive function and FC between the NC and CI groups was investigated first, and then the change in cognitive function and FC after carotid revascularization was investigated in the CI group. There were 11 and 16 patients in the NC and CI groups, respectively. The FC of the medial prefrontal cortex with the precuneus and that of the left lateral parietal cortex (LLP) with the right cerebellum were significantly lower in the CI group than in the NC group. In the CI group, significant improvements were found in MMSE (25.3 vs 26.8, p = 0.02), FAB (14.4 vs 15.6, p = 0.01), and MoCA scores (20.1 vs 23.9, p = 0.0001) after revascularization surgery. Significantly increased FC of the LLP with the right intracalcarine cortex, right lingual gyrus, and precuneus was observed after carotid revascularization. In addition, there was a significant positive correlation between the increased FC of the LLP with the precuneus and improvement in the MoCA score after carotid revascularization. These findings suggest that carotid revascularization, including CEA and CAS, might improve cognitive function based on brain FC in the DMN in carotid stenosis patients with CI.

Memory, Executive, and Intellectual Functions in Adults with Moyamoya Disease

Cognitive function can decline in adults with moyamoya disease (MMD). Memory, which is an essential but complex and multifaceted function, underpins executive and intellectual functions. However, the relationship between memory and executive or intellectual functions in adults with MMD has not been well studied. The relationship between memory and cerebral blood flow has also not been elucidated. This study investigated correlations between memory, executive function, and intellectual function, and associations between cerebral blood flow and memory in adults with MMD. Memory, executive function, and intellectual function were assessed using the Wechsler Memory Scale-Revised (WMS-R), Frontal Assessment Battery (FAB), and Wechsler Adult Intelligence Scale (WAIS) third or fourth edition, respectively, in 31 adults with MMD. Cerebral blood flow was measured with iodine 123I-iodoamphetamine single-photon emission computed tomography. WMS-R scores correlated significantly with total FAB and WAIS scores before and after revascularization. Cerebral blood flow in the left posterior cerebral artery territory correlated positively with WMS-R and WAIS scores pre- and postoperatively. Postoperative cerebrovascular reserves of the right cerebellum, pons, and vermis were positively associated with visual memory, and postoperative cerebrovascular reserve of the pons was also associated with general memory. Memory function correlates with executive and intellectual functions in adults with MMD. The FAB, which requires about 10min to administer, might be useful to screen for memory dysfunction. Memory might be vulnerable to hypoperfusion in the posterior cerebral artery territory among adults with MMD. Postoperative cerebrovascular reserve might help predict memory dysfunction in adults with MMD.

Enzymatic properties and clinical associations of serum alpha-galactosidase A in Parkinson's disease.

Recent studies have revealed an association between Parkinson's disease (PD) and Fabry disease, a lysosomal storage disorder; however, the underlying mechanisms remain to be elucidated. This study aimed to investigate the enzymatic properties of serum alpha-galactosidase A (GLA) and compared them with the clinical parameters of PD. The study participants consisted of 66 sporadic PD patients and 52 controls. We measured serum GLA activity and calculated the apparent Michaelis constant (Km ) and maximal velocity (Vmax ) by Lineweaver-Burk plot analysis. Serum GLA protein concentration was measured by enzyme-linked immunosorbent assay. We examined the potential correlations between serum GLA activity and GLA protein concentration and clinical features and the plasma neurofilament light chain (NfL) level. Compared to controls, PD patients showed significantly lower serum GLA activity (P < 0.0001) and apparent Vmax (P = 0.0131), but no change in the apparent Km value. Serum GLA protein concentration was lower in the PD group (P = 0.0168) and was positively associated with GLA activity. Serum GLA activity and GLA protein concentration in the PD group showed a negative correlation with age. Additionally, serum GLA activity was negatively correlated with the motor severity score and the level of plasma NfL, and was positively correlated with the score of frontal assessment battery. This study highlights that the lower serum GLA activity in PD is the result of a quantitative decrement of GLA protein in the serum and that it may serve as a biomarker of disease severity.

Dual-task multicomponent exercise-cognitive intervention improved cognitive function and functional fitness in older adults.

Maintaining cognitive and physical function is essential to healthy aging. This study aims to investigate the effect of an exercise-cognitive dual-task program in Chinese language on cognitive function and functional fitness in older adults. Seventy adults aged 60-84years were conveniently assigned to one of the three groups: exercise-cognitive dual-task (EC) group (n = 28), exercise group (n = 22), and control group (n = 20). The EC group received a 90-min class including multicomponent exercise-cognitive dual-task twice a week. The exercise group received a 90-min class including multicomponent exercise twice a week. The control group maintained their regular level of physical activity and general lifestyle. Cognitive functions and functional fitness were measured before and after the 12-week intervention. The participants in the EC and exercise group significantly improved scores in Taiwanese Frontal Assessment Battery, the Chang Gung University Orthographical Fluency Test, and the Mini-Mental State Examination; however, those in the control group did not. The participants in the EC and exercise group showed significant increases in almost all functional fitness tests. The participants in the EC group showed significantly higher improvements in Chang Gung University Orthographical Fluency Test score and aerobic endurance than the exercise group and in Chang Gung University Orthographical Fluency Test score and lower body strength than the control group. In addition, the changes in Taiwanese Frontal Assessment Battery and Mini-Mental State Examination scores were significantly correlated with the changes in functional fitness. The dual-task intervention resulted in greater improvements in verbal fluency, endurance, and muscular strength than exercise alone and control.

The Single-Matrix Digit Cancellation Test, a Screener for Selective Attention Deficits: Standardization in an Italian Population Sample and Clinical Usability in Acute Stroke Patients

Introduction: This study aimed at validating and providing Italian norms for the Single-Matrix Digit Cancellation Test (SMDCT), a cancellation task to screen for selective attention deficits, as well as providing clinical usability evidence for it in acute stroke patients. Methods: The SMDCT stimulus is a specular, 4-quadrant, horizontally oriented matrix, across which target distribution is homogeneous. Both accuracy (-A) and time (-T) outcomes were computed. N = 263 healthy participants (HPs) and N = 76 acute stroke patients were recruited. N = 108 HPs also underwent the Mini-Mental State Examination, Frontal Assessment Battery (FAB), and Trail-Making Test (TMT), while patients were further assessed by the Mental Performance in Acute Stroke (MEPS). Regression-based norms were derived (equivalent scores). Construct and factorial validity, as well as case-control discrimination, were tested. Results: The matrix was underpinned by a two-component structure reflecting left and right hits. The SMDCT-T and -A were associated with TMT and FAB scores, respectively. Education predicted the SMDCT-A/-T, whereas age predicted the SMDCT-T only. In patients, the SMDCT converged with the MEPS, also accurately discriminating them from HPs. An index of right-left difference differentiated right- from left-damaged patients. Conclusions: The SMDCT is a valid and normed screener for selective attention deficits, encompassing measures of both accuracy and time, whose adoption is encouraged in acute stroke patients. Relatedly, the horizontal disposition of its matrix does allow for the qualitative report of either leftward of rightward biases due to underlying visual or attentional-representational deficits in this population.

Altered brain energy metabolism related to astrocytes in tauopathies

AbstractBackgroundAccumulated evidence suggests altered energy metabolism in the brain of tauopathies. In Alzheimer’s disease (AD) and progressive supranuclear palsy (PSP), decreased fluorodeoxyglucose (FDG) uptake in the cingulate cortex is considered a marker of neurodegeneration. However, its underlying pathogenesis remains unknown. It is hypothesized that lactate, a glucose metabolite, is produced in astrocytes and subsequently shuttles to neurons as an energy substrate. The current study aims to examine alterations in lactate and glucose concentrations and their association with astrocytic activities in the cingulate cortex of patients with AD and PSP.MethodThirty AD, 30 PSP, and 30 healthy control (HC) subjects were enrolled. Lactate, glucose, and myoinositol (mI), an astroglial marker, in the anterior cingulate cortex (ACC) and posterior cingulate cortex (PCC) were determined by magnetic resonance spectroscopy (MRS) (3T scanner, SPECIAL sequence, TR/TE 3000/8.5ms, LCModel analysis) (Figure 1). Tau depositions were assessed using PET imaging with 18F‐PM‐PBB3.ResultAll the patients with AD and PSP were confirmed to have the typical distribution of tau pathology. Lactate, glucose, and mI levels were higher in the ACC in PSP and AD, and PCC in AD compared to HC (p &lt; 0.05) (Figure 2). In these cortical regions, lactate levels showed a positive correlation with mI levels (p &lt; 0.05) (Figure 3). Lactate levels in the PCC in AD patients showed a positive correlation with Clinical Dementia Rating‐Sum of Boxes (CDR‐SB) scores (p &lt; 0.05) (Figure 4). Moreover, mI levels in the ACC in PSP patients were negatively correlated with Frontal Assessment Battery (FAB) scores (p &lt; 0.05) (Figure 4).ConclusionWe found elevated lactate and glucose levels accompanied by an increased astroglial marker mainly in the PCC in AD and ACC in PSP patients. Moreover, elevated lactate and mI levels in the cingulate cortex reflected the cognitive decline of AD and PSP, respectively. The excess lactate and glucose levels in the disease‐specific regions might reflect decreased energy utilization as shown in previous FDG‐PET studies. Given the residual lactate levels were correlated with mI levels, we speculated that the impaired lactate shuttle of reactivated astrocytes disrupts energy metabolism, leading to cognitive dysfunctions.

The Prognostic Utility of a Geriatric Assessment for Patients with Pancreatic Cancer Receiving Gemcitabine-based Chemotherapy: A Prospective Observational Study.

Objective To evaluate the effect of a pretreatment geriatric assessment on the clinical outcomes in older patients with unresectable or recurrent pancreatic ductal adenocarcinoma (PDAC) scheduled to receive gemcitabine (GEM)/GEM+nab-paclitaxel (GnP). Patients Older patients with unresectable PDAC scheduled to receive GEM/GnP who visited Kyorin University Hospital and cooperating institutions were enrolled and followed from April 2015 to March 2020. The maximum observation period was two years. All patients underwent a cancer-specific geriatric assessment (CSGA) and optional geriatric assessment (GA) before treatment initiation and two months after the start of treatment. The patients' background characteristics, tumor progression, tumor site, and regimen (GEM/GnP) were examined in a Cox proportional hazards model. The relationship between the overall survival (OS) and GA score was also determined. Eligible patients (age ≥70 years old with histopathologically confirmed unresectable or recurrent PDAC) were scheduled to receive first-line chemotherapy. Results The performance status (PS) and activities of daily living (ADL)/instrumental ADL (IADL) scores at baseline correlated with the OS. Furthermore, even in cases with normal baseline values, lower Frontal Assessment Battery scores and higher Geriatric Depression Scale-Short Form scores after treatment initiation were significantly correlated with OS. Conclusion The baseline PS, ADL, and IADL may be prognostic factors in older PDAC patients. In addition, a normal frontal lobe function and depression scores prior to treatment initiation that rapidly worsened during treatment were independently associated with a reduced OS. Selecting appropriate interventions and improving the therapeutic environment may prolong the OS in such patients.

Venous flow disturbance links to the cognitive function in the ultrasonographical validation study

AbstractBackgroundAccording to the dementia progression, especially in Alzheimer’s disease (AD), venous reflex disturbance may be concerned. We previously found and reported that the validation of the spontaneous echo contrast or velocities of the internal jugular vein are convenient AD diagnosis screening methods and that the venous reflux disturbance correlates with AD development (Matsuzono K et al. J Alzheimers Dis. 2021;84(2):787‐796). In order to clear the relationship between venous reflex disturbance and dementia, we performed the additional study using the transesophageal echocardiography (TEE).MethodWe performed the TEE examination and the higher brain function test to the 80 participants. According to the TEE examination, we validated 1) the spontaneous echo contrast in heart, 2) shunt including the patent foramen ovale, 3) velocities at the left atrial appendage, and 4) the plaque length at the aortic arch. According to the higher brain function, we validated the Mini‐Mental State Examination (MMSE), Hasegawa Dementia Rating Scale‐Revised (HDS‐R), and Frontal Assessment Battery (FAB).ResultTwenty‐six (32.5%) of the 80 participants showed positive spontaneous echo contrast in the heart. All the MMSE, HDS‐R, and FAB scores of the positive group was significantly lower than that of the negative (26 vs 24, 26 vs 22.5, 14 vs 10.5, p&lt;0.05). According to the shunt, there was no significant relationship to the cognitive function. The velocities at the left atrial appendage showed positive correlation while the plaque length at the aortic arch showed negative correlation to the cognitive function (r = 0.2).ConclusionIn both of the internal jugular vein and of the heart, the spontaneous echo contrast significantly correlates with the cognitive impairment. Our study using the ultrasonographical examination shows the venous reflex disturbance concerns with the dementia progression.

Prefrontal activation during dual-task seated stepping and walking performed by subacute stroke patients with hemiplegia.

This study examined prefrontal cortex (PFC) activation during dual-task seated stepping and walking performed by subacute stroke patients with hemiplegia and evaluated the relationship between PFC activation, frontal lobe functions, and dual-task interference. Patients with functional ambulation category (FAC) scores ≤ 2 comprised the seated stepping task group. Those with FAC scores > 2 comprised the walking task group. There were 11 patients in the seated stepping task group (mean age, 65.3±12.2 years; age range, 55-73.5 years; 7 male and 4 female patients; time since stroke onset, 45.7±9.9 days) and 11 patients in the walking task group (mean age, 65.6±15.2 years; age range, 49.5-74.5 years; 7 male and 4 female patients; time since stroke onset, 57.5±18.3 days). Both groups completed the Frontal Assessment Battery (FAB). The seated stepping task group performed the following three tasks: cognitive task (CT), normal seated stepping (NSS), and dual-task seated stepping (DTSS). The walking task group completed the following tasks: CT, normal walking (NW), and dual-task walking (DTW). The CT was a letter fluency task; this letter fluency task was simultaneously performed during seated stepping (DTSS) and walking (DTW). Changes in the oxygenated hemoglobin (O2Hb) concentration and deoxygenated hemoglobin concentration during the tasks were measured using near-infrared spectroscopy (Pocket NIRS HM; Dynasense Inc., Japan). The number of steps, walking speed, and percentage of correct responses to the CT were recorded. The results showed that DTSS activated the PFC significantly more than performing a single task and that NSS was associated with a significantly higher difference in the hemoglobin concentration when compared to that associated with the CT, which was a single task. In the walking task group, PFC activation was significantly higher during DTW, NW, and CT (in that order), and O2Hb concentrations were significantly higher in the contralesional hemisphere than in the ipsilesional hemisphere during all tasks. Associations between PFC activation, FAB scores, and dual-task interference in the seated task group indicated significant positive correlations between FAB scores and cognitive performance with dual-task interference. DTSS may be an effective means of activating the PFC of patients with difficulty walking.

Orthostatic hypotension and executive function in older people from the French MERE cohort attending a memory clinic

Orthostatic hypotension (OH) seems to be implicated in cognitive impairment. Nevertheless, not all the cognitive functions affected by OH have been identified.Participants from the MERE cohort were evaluated for OH (i.e. drop in blood pressure ≥20 mmHg for systolic and ≥10 mmHg for diastolic between lying and standing) and executive functions, implicated in brain motor control, and evaluated with the Frontal Assessment Battery (FAB) and its sub-scores.Of the 1573 patients selected, 338 had OH (21.5 %). We found an inverse cross-sectional association between OH and linear FAB score and an association with the sub-score for the motor sequence of Luria.In the MERE cohort, OH was associated with executive function disorder and with a pathological motor sequence of Luria as a melo-kinetic praxis disorder.

Long-term changes in cognitive status of patients with type 2 diabetes mellitus after coronary artery bypass graft surgery

Aim. To study long-term changes (5 to 7 years after coronary artery bypass graft (CABG) surgery) in cognitive status of patients with type 2 diabetes.Materials and Methods. The study included 47 male patients admitted to the Research Institute for Complex Issues of Cardiovascular Diseases for the CABG surgery. Criteria of inclusion were signed informed consent, age from 40 to 75 years, male gender, planned on-pump CABG surgery, and right-handedness. Criteria of exclusion were brain pathology at multislice computed tomography, chronic cerebral ischemia grade II-IV, Beck Depression Inventory score &gt; 16 points, the Mini-Mental State Examination (MMSE) score &lt; 24 points and the Frontal Assessment Battery score &lt; 11 points, arrhythmia, class IIB-IV chronic heart failure stage IIB, chronic obstructive pulmonary disease, cancer, and past medical history of brain injury or stroke. Pre-operative examination of patients classified them into two groups: with (n = 21) and without (n = 26) type 2 diabetes mellitus (DM).Results. 5-7 years after CABG surgery, patients with type 2 DM had a cognitive decline according to MMSE scale as compared to the preoperative level (28,0 [27,0; 29,0] and 27,0 [26,0; 28,0], p = 0.04). In keeping with these findings, odds ratio (OR) of mild cognitive impairment (MCI) in patients with type 2 DM was 1.92 (95% CI = 1.09- 3.37, p = 0.02). Psychomotor and executive functions were reduced in patients with type 2 DM both at baseline and in particular 5-7 years after CABG (p ≤ 0.05). The correlation between glycated hemoglobin (HbA1c) and cognitive parameters were found only in patients with type 2 DM. Higher HbA1c level was also associated with deteriorated executive functions and short-term memory.Conclusion. 5−7 years after CABG surgery, patients with type 2 DM suffer from a cognitive decline and reduced psychomotor and executive functions.