High Prevalence Of Cognitive Impairment Research Articles

Do Communication Patterns Affect the Association between Cognitive Impairment and Hearing Loss among Older Adults in Vietnam?

This study examined the prevalence of cognitive impairment among older adults in central Vietnam and the roles of communication (with or without communication devices) in the association between cognitive impairment and hearing loss. This cross-sectional study was performed on 725 randomly selected community-dwelling older adults aged ≥60 years from Thua Thien Hue province, Vietnam. Participants attended a face-to-face survey. Sociodemographic characteristics, social interaction with or without communication devices, health status and cognitive function using the Mini-Mental State Examination were reported. Ordinal logistic regression analysis was performed to quantify the association between hearing loss and cognitive function by frequency of communication with and without devices. Mild and severe cognitive impairment had prevalence rates of 23.6% and 19.3%, respectively. Cognitive impairment was more prevalent among older adults with hearing-loss, vision loss and difficulties with instrumental activities of daily living (IADL). The association between hearing loss and cognitive impairment was not significant when older adults had frequent communication with others using devices. This study presented the relatively high prevalence of cognitive impairment in community-dwelling older adults in Vietnam. Frequent communication using devices attenuated the association between hearing loss and cognitive impairment.

Risk Factors and Clinical Outcomes of Cognitive Impairment in Diabetic Patients Undergoing Peritoneal Dialysis

Introduction: Cognitive impairment (CI) is common in patients with CKD or diabetes mellitus (DM). However, the relevance between DM and CI in diabetic patients undergoing peritoneal dialysis (PD) has not been clearly established. This study aimed to explore the role of DM in CI, the association of glycemic control with CI, and clinical outcomes of CI in diabetic PD patients. Methods: Continuous ambulatory PD (CAPD) patients followed up in our PD center between 2014 and 2016 were enrolled. The participants were followed until an endpoint was reached or December 2017. Demographic data and clinical characteristics were collected, and laboratory parameters were measured. The Montreal Cognitive Assessment (MoCA) was used to evaluate global cognitive function, and a score of <26 was considered to indicate CI. A propensity score matching according to age, gender, and mean arterial pressure was conducted between the DM and non-DM groups. Results: A total of 913 CAPD patients were enrolled, of whom 186 (20.4%) had diabetes. After appropriate matching, 175 patients in the DM group and 270 patients in the non-DM group were included. Patients with diabetes had a higher prevalence of CI and lower scores for visuospatial/executive function, naming, language, delayed recall, and orientation. Higher HbA1c (odds ratio [OR], 1.547; 95% confidence interval [95% CI], 1.013–2.362) and cardiovascular disease (CVD; OR, 2.926; 95% CI, 1.139–7.516) significantly correlated with a risk of CI in diabetic patients. During a median of 26.0 (interquartile range 13.5–35.6) months of follow-up, diabetic patients with CI demonstrated a significantly lower survival rate than those without CI, and CI was an independent risk factor for mortality after adjustment (hazard ratio, 7.224; 95% CI, 1.694–30.806). However, they did not show worse technique survival or higher peritonitis rate than patients without CI. Conclusions: HbA1c and CVD are independent risk factors for CI in diabetic patients undergoing CAPD, and CI is independently associated with a higher risk of mortality.

Характеристики пожилого пациента с когнитивными расстройствами в амбулаторной практике

Aim: to study the prevalence of cognitive impairments (CI) in patients over 65 y.o., determine concomitant diseases and factors affecting cognitive functions (CF). Patients and Methods: a single-stage cross-sectional study of a continuous sample of patients (over 65 y.o. who applied for outpatient care from 24.10.2019 to 15.12.2019) in St. Petersburg was conducted. The study methods included: Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), blood pressure (BP) test, the study of outpatient medical histories, assessment of pharmacological treatment, laboratory studies (clinical blood count, lipid profile, hormonal studies, blood glucose level, transaminases and creatinine level). Results: the prevalence of mild cognitive impairment (MCI) among the study subjects was 62.9% (95% CI 5670), severe cognitive impairment (SCI) — 8.2%. After covariate adjustment, hypertension, acute cerebrovascular accident (ACVA), complaints of poor sleep quality, subjective cognitive complaints, and depression symptoms were associated with a decrease in CF. The male sex was associated with a decrease in memory function (p=0.03), hypertension — with a decrease in total CF, memory function (p=0.03) and constructive praxis (p=0.01), depression — with a decrease in total CF and indicators of attention mechanism (p&lt;0.01), diabetes mellitus (DM) — with a decrease in thinking function (p=0.01), reduced hemoglobin level — with a decrease in total CF and memory function (p&lt;0.01), β-blockers intake — with a decrease in total CF, the function of verbal fluency (p=0.01), thinking (p&lt;0.01) and memory (p&lt;0.01). Conclusion: the high prevalence of CI was revealed among elderly and senile patients who sought outpatient care. The association of hypertension, anemia, DM, depression symptoms and β-blockers intake with CF deterioration in the elderly and senile age was determined. KEYWORDS: elderly and senile age, cognitive disorders, dementia, risk factors, screening for cognitive impairment, MoCA. FOR CITATION: Turusheva A.V., Bogdanova T.A., Frolova E.V., Logunov D.L. Characteristics of an elderly patient with cognitive impairments in outpatient practice. Russian Medical Inquiry. 2021;5(10):618–622 (in Russ.). DOI: 10.32364/2587-6821-2021-5-10-618-622.

Does cognitive impairment in bipolar disorder impact on a SIMPLe app use?

BackgroundSmartphone apps are becoming increasingly used by service users in mental health care and research for diverse aims. However, it is well-known the high prevalence of cognitive impairment in some people suffering from severe mental illnesses such as bipolar disorder (BD), which impacts on their psychosocial functioning and quality of life. In this context, the main aim of this paper is to investigate through exploratory analyses the role of specific cognitive deficits in the retention, engagement, and usability of a psychoeducational smartphone app in a group of patients with BD. Methods51 remitted BD patients were asked to use the app for 3 months. Baseline and 3-months follow-up clinical and usability assessments were conducted. Twenty-seven independent results from a comprehensive neurocognitive test of the same participants were retrieved separately of the 2 years before or after the use of the app. Post-hoc exploratory analyses were carried out using Spearman correlations to identify significant cognitive deficits domains influencing the usability and retention with the app. ResultsThere were no statistically significant cognitive variables associated with the use, reported usability or retention with the app. Some variables associated with executive functions, verbal and visual memory correlated significantly with previous use of smartphones. LimitationsPost-hoc analysis with a limited sample size. ConclusionThese preliminary results suggests that patients with BD and mild cognitive deficits do not present any limitation in using mental health apps. In our case, the adoption of a user-centred design in the development process of the app could have mitigated the participants' difficulties when using the app.

Mental stress-induced myocardial ischemia and cognitive impairment in coronary atherosclerosis

ObjectiveTo understand if presence of mental stress-induced myocardial ischemia (MSIMI) is associated with higher prevalence of cognitive impairment at baseline and its decline over time. MethodsA cohort of participants with stable coronary atherosclerosis underwent acute mental stress testing using a series of standardized speech/arithmetic stressors. The stress/rest digital vasomotor response to mental stress (sPAT) was assessed to measure microvascular constriction during mental stress. Patients received 99mTc-sestamibi myocardial perfusion imaging at rest, with mental stress and with conventional (exercise/pharmacological) stress. Cognitive function was assessed both at baseline and at a 2 year follow-up using the Trail Making Test parts A and B and the verbal and visual memory subtests of the Wechsler Memory Scale. ResultsWe studied 486 individuals (72% male, 32.1% Black, 62 ± 9 (mean ± SD) years old). After multivariable adjustment for baseline demographics, risk factors, and medication use, presence of MSIMI was associated with 21% and 20% slower completion of Trail-A and Trail-B, respectively (p for all <0.01). After a 2-year follow-up period, presence of MSIMI was associated with a 33% slower completion of Trail-B, denoting cognitive decline (B = 0.33, 95% CI, 0.04, 0.62). A lower sPAT, indicating greater vasoconstriction, mediated the association between MSIMI and worsening Trail-B performance by 18.2%. Ischemia with a conventional stress test was not associated with any of the cognitive tests over time. ConclusionMSIMI is associated with slower visuomotor processing and worse executive function at baseline and with greater decline in these abilities over time.

The apolipoprotein E ε4 allele‐dependent relationship between serum lipid levels and cognitive function: A population‐based cross‐sectional study

AbstractBackgroundTill now, the effect of serum lipid levels on cognitive function is still controversial. The apolipoprotein E ε4 (APOE) allele is the most critical genetic risk factor for Alzheimer’s disease and cognitive impairment. Additionally, APOE ε4 allele has a major impact on lipid metabolism. The aim of this study was to investigate the APOE genotype‐dependent relationship between peripheral serum lipid levels and cognitive impairment.Method1273 subjects aged 40‐86 years participated in this cross‐sectional study. Serum lipid levels and the APOE genotype were detected. Mini‐mental state examination was used to diagnose the cognitive impairment or not. Univariate and multivariate analyses were used to analyze the relationships between APOE genotype, serum lipid levels and cognition function.ResultAfter controlling for all possible covariates, a significant interaction between low serum high density lipoprotein and the APOE ε4 allele on cognitive impairment (Wald's chi‐square=4.269, df=1, OR=20.094, p=0.039) (Table 1) was found in the total participants. In APOE ε4 carriers, low serum high density lipoprotein was positively associated with cognitive impairment (Wald's chi‐square=8.200, df=1, OR=60.335, p=0.004) (Table 2), and serum high density lipoprotein levels were positively correlated with Mini‐mental state examination score (r=0.217, df=176, p=0.004). There was no significant correlation between serum total cholesterol, low‐density lipoprotein, triglycerides levels and cognitive impairment in either the total participants or APOE ε4 carriers/non‐carriers. (Figure 1).ConclusionAPOE ε4 carriers, but not non‐carriers, with lower serum high‐density lipoprotein had a higher prevalence of cognitive impairment and a lower Mini‐mental state examination score. These results suggest that the APOE ε4 allele may affect the relationship between serum lipid levels and cognitive impairment. However, the specific mechanism needs to be further elucidated.

Prevalence of memory impairment 2000‐2015 in Sao Paolo, Brazil

AbstractBackgroundDecreases in prevalence of memory impairment and dementia over the last two decades have been observed in different countries for cohorts entering older age. We sought to explore the changes in prevalence of cognitive impairment across four waves of the Health, Welfare and Aging survey (SABE) with data collected in Sao Paolo, Brazil, in 2000, 2006, 2010, and 2015.MethodMini Mental State Exam (MMSE) scores and covariate values were available for 5,191 respondents (62.4% female) aged 60 to 99 across four waves. Cognitive impairment was defined as having &lt;=12 points on a 19‐point abbreviated version of the MMSE. Age group, educational attainment (no formal schooling, primary, secondary, post‐secondary), self‐reported heart disease, stroke, diabetes, hypertension, and BMI (&lt;18.5, 18.5‐24.9, 25‐29.9, 30+) were adjusted for.ResultIn more recent waves, prevalence of cognitive impairment was higher for respondents aged 60‐64 years (9.0% in 2015 vs. 4.6% in 2000), 65‐69 years (9.7% in 2015 vs. 5.8% in 2006) and 70‐74 years (13.9% in 2015 vs. 5.8% in 2006). Between 2015 and 2000, respondents were increasingly more likely to report some formal education (90.8% vs. 75.3%), secondary (17.6% vs. 7.3%) or post‐secondary education (11.4% vs. 4.3%). Respondents were increasingly more likely to report hypertension (66.5% vs. 54.2%), diabetes (28.7% vs. 17.8%), and be overweight/obese (74.1% vs. 58.9%). In covariate‐adjusted logistic regressions, respondents in 2015 were more likely to show cognitive impairment compared to 2000 (OR 1.84, CI 1.20‐2.82). In age‐stratified analyses, younger respondents were more likely to show cognitive impairment over time (aged 60‐64 years: OR 3.52, CI 1.98‐6.26; aged 65‐69 years: OR 3.31, CI 1.50‐7.33; aged 70‐74 years: OR 3.11, CI 1.37‐7.09).ConclusionSABE respondents younger than 75 years showed higher prevalence of cognitive impairment in 2015 compared to respondents of the same age in earlier waves after adjusting for chronic disease burden and educational attainment. In contrast to decreases in prevalence of memory impairment in other countries and despite increases in educational attainment of SABE respondents, the findings suggest that the more recently born cohorts residing in Sao Paolo have entered older age in a cognitively less healthy status.

Neuropsychiatric index and relationship quality for caregivers of older Mexican Americans

AbstractBackgroundInformal caregivers play a key role in supporting older Mexican Americans, as they are less likely to enter nursing facilities than other racial/ethnic groups in the U.S, even when faced with high levels of physical and cognitive impairment. The quality of caregiving relationships is directly related to caregiver stress. However, there is little research on the correlates of caregiver assessment of relationship quality. Assessment of caregiver relationship quality is especially important for Mexican American older adult caregivers due to the high prevalence of cognitive impairment and dementia in this population.MethodsUsing data from caregiver supplement of the wave 7 of the Hispanic Established Population for the Epidemiologic Study of Elderly (HEPESE)(n=460) study of very old (Age 85+) Mexican Americans we examine the association of relationship quality with care recipient health, caregiver health, and caregiver finances. Caregiver relationship quality is measured using both positive and negative relationship assessments separately. We use linear regression to examine the correlates of caregiver relationship quality net of caregiver and care recipient demographics, care recipient physical (caregiver‐rated health, ADL and IADL disability) and mental health (caregiver‐rated NPI and care recipient MMSE), caregiver health (caregiver‐rated health and depression) caregiver finances (income and financial burden).ResultsCaregivers who were married to the care recipient reported both less positive and more negative assessments. Male care recipients, married caregivers, and caregiver depression were related to positive but not negative assessments. Both positive and negative assessments were significantly associated with IADL disability and NPI score but not MMSE score.ConclusionsRelationship quality for Mexican Americans among the very old is related to hands‐on care tasks and not financial strain. Disability status suggests that early changes in functional status are more stressful than more severe disability due to adjustment periods. Married caregivers may report higher relationship quality due to additional support from spouses in caregiving roles. NPI status is the most strongly associated correlate of both positive and negative relationship quality, while MMSE was not significantly related to either. Our results suggest that caregiver assessments of behavioral disturbances are more important to relationship quality than care recipient tested cognitive functioning.

Acuity Differences Among Newly Admitted Older Residents in Rural and Urban Nursing Homes.

Our primary objective was to assess rural-urban acuity differences among newly admitted older nursing home residents. Data included the 2015 Minimum Data Set v3.0, the Area Health Resources File, the Provider of Services File, and Rural-Urban Commuting Area codes. Activities of daily living, the Cognitive Function Scale, and aggression/wandering indicators were used to assess functional, cognitive, and behavioral status, respectively. Excluding assessments for short stays (less than 90 days), assessments for 209,719 newly admitted long-stay residents aged 65 and older across 14,834 facilities in 47 states were evaluated. Difference in differences (DID) generalized linear models with state-fixed effects and clustering by facilities were used to assess the interaction effect of older age (75 plus) on rural-urban acuity differences, controlling for socioeconomic factors, admission source, and market characteristics. Residents admitted to rural facilities were less functionally impaired (incidence rate ratio: 0.973-0.898) but had more cognitive (odds ratio [OR]: 1.03-1.22) and problem behaviors (OR: 1.19-1.48) than urban. Although older age was predictive of higher acuity, in DID models, the expected decline in functional status was comparable in rural and urban facilities, while the cognitive and behavioral status for older admissions was 8.0% and 8.5% lower in rural versus urban facilities, respectively. Although the higher prevalence of cognitive impairment and problem behaviors among rural admissions was attributable in part to older age, rural facilities admitted less complex individuals among older age residents than urban facilities. Findings may reflect less capacity to manage older, complex individuals in rural facilities.

Cognitive Performance and Neuro-Metabolites in HIV Using 3T Magnetic Resonance Spectroscopy: A Cross-Sectional Study from India.

Cognitive impairment in patients with human immunodeficiency virus (HIV) is associated with higher morbidity. The prevalence of the metabolite changes in the brain associated with cognitive impairment in anti-retroviral therapy naïve patients with HIV is unknown. To estimate the prevalence of the neurometabolites associated with cognitive impairment in antiretroviral therapy (ART) naïve patients with HIV. We conducted a cross-sectional study among ART naïve patients with HIV aged 18-50 years in a tertiary care center in India. Cognition was tested using the Post Graduate Institute battery of brain dysfunction across five domains; memory, attention-information processing, abstraction executive, complex perceptual, and simple motor skills. We assessed the total N-acetyl aspartyl (tNAA), creatine (tCr) and glutamate + glutamine (Glx) using 3T magnetic resonance spectroscopy. Cognitive impairment was defined as an impairment in ≥2 domains. Among 43 patients eligible for this study, the median age was 32 years (IQR 29, 40) and 30% were women. Median CD4 count and viral load were 317 cells/μL (IQR 157, 456) and 9.3 copies/ μL (IQR 1.4, 38), respectively. Impairment in at least one cognitive domain was present in 32 patients (74.4%). Impairment in simple motor skills and memory was present in 46.5% and 44% of patients, respectively. Cognitive impairment, defined by impairment in ≥2 domains, was found in 22 (51.2%) patients. There was a trend towards higher concentration of tNAA (7.3 vs. 7.0 mmol/kg), tGlx (9.1 vs. 8.2 mmol/kg), and tCr (5.5 vs. 5.2 mmol/kg) in the frontal lobe of patients with cognitive impairment vs. without cognitive impairment but it did not reach statistical significance (p>0.05 for all). There was no difference in the concentration of these metabolites in the two groups in the basal ganglia. There is a high prevalence of cognitive impairment in ART naïve patients with HIV. There is no difference in metabolites in patients with or without cognitive impairment. Further studies, with longitudinal follow-up are required to understand the underlying pathophysiological mechanisms.

Schizophrenic patients\u2019 cognitive functions in relation to their metabolic profile: a cross-sectional, comparative study on an Egyptian sample

BackgroundPatients with schizophrenia suffer from diffuse cognitive impairment and high prevalence of cardiovascular metabolic risks, associated with poor clinical outcomes. We aimed in this study to test the presence of cognitive impairment in a sample of patients with schizophrenia, and evaluate its possible relations to patients’ metabolic profile. We recruited forty patients diagnosed with schizophrenia and their matched controls from the inpatient departments and outpatient services from January to December 2016. Schizophrenia diagnosis was confirmed by the ICD10 criteria checklist. Symptoms profile and severity were assessed by the Positive and Negative Syndrome Scale. Cognitive profile was assessed through (1) Trail Making Test, Parts A and B and (2) Wechsler Memory Scale-Revised Visual Reproduction Test. Metabolic profile was assessed by measuring the body mass index, fasting blood glucose, and lipid profile. SPSS (V. 22.0, IBM Corp., USA, 2013) was used for data analysis.ResultsThe patients group had a significantly higher means in the speed of processing, executive function, attention, and working memory scores on TMT-A (p = 0.0), TMT-B (p = 0.00), and WMS-R (p = 0.029) and significantly higher FBG levels (p = 0.00). Correlation studies showed that the increase in patients’ age, illness duration, treatments, number of hospitalizations, number of episodes and of ECT sessions received, symptoms severity, and deficits in cognitive function scores was associated with higher BMI and FBG.ConclusionsPatients with schizophrenia have a higher prevalence of cognitive impairment and vascular risk factors than the general population. Close monitoring and early management of these risk factors can promote better cognitive abilities and overall functions.

Female sex is strongly associated with cognitive impairment in HIV infection.

Neurocognitive disorders remain frequent despite highly active antiretroviral treatment (HAART). The CNS is known as the sanctuary of HIV infection, where persistent neuroinflammation occurs regardless of viral suppression. Moreover, opportunistic infections, neurovascular damage and HAART neurotoxicity contribute to neurocognitive impairment. Therefore, detailed epidemiological studies might help to elucidate those complex mechanisms. To investigate the prevalence of cognitive impairment and the associated sociodemographic, clinical and neuropsychological variables among HIV-infected patients admitted to a tertiary centre, in southern Brazil. An observational, cross-sectional and analytic study was conducted between February 2019 and March 2020, in Hospital Nereu Ramos (HNR), with148 HIV-infected patients. They were interviewed, submitted to the International HIV Dementia Scale (IHDS) and had their medical data analysed. The prevalence of cognitive impairment was 69.6%. It was higher among women (OR = 3.5; 95% CI 1.5-8; p < 0.01), independently of depression, educational status and age. Full years of schooling were strongly associated with IHDS scores (p < 0.01). Patient Health Questionnaire-9 (PHQ-9) scores for depression (p = 0.8), time since HIV diagnosis (p = 0.2), CD4+ cell counts (p = 0.8) and viral load (p = 0.8) were not associated with IHDS scale. A high prevalence of cognitive impairment in HIV-infected patients was identified, independently associated with the female sex and fewer years of schooling. Further studies are needed to clarify the differences in the pathophysiology between sexes and the role of cognitive reserve in prevention of cognitive impairment in HIV infection.

Psychiatric morbidity among patients attending a rural non-communicable disease clinic

Abstract Background The presence of psychiatric illness among patients with physical illnesses leads to poor treatment adherence, poor lifestyle, increased cost of treatment, poor quality of life, worsening of physical illness, work absenteeism, increased hospital visits, poor self-care and higher mortality. The study evaluated the prevalence of cognitive impairment and psychiatric morbidity in non-communicable disease patients. The study highlights that NCD patients should be provided information about the development of cognitive impairment in order to prevent it. Methods It was a cross-sectional study conducted among the patients attending the non-communicable disease clinic of a rural community health centre run in collaboration with the Postgraduate Institute Medical Education and Research (PGIMER), Chandigarh. We registered 124 patients after obtaining written informed consent. Instruments: Hindi Mental Status Examination (HMSE), Patient Health Questionnaire-9, Generalized anxiety disorder-7 (GAD-7) scale. Analysis of covariance was applied to see the relationship between the domain of the HMSE and NCDs. Results The mean age of the participants was 55.5 years (SD-11.9, Range-26-90). A little more than one third (N = 48, 38.7%) were diagnosed with hypertension only, one-sixth (N = 22; 17.7%) were diagnosed with diabetes mellitus only, and 54 (43.5%) patients were diagnosed with both hypertension and diabetes mellitus. A slightly more than one-third of the study participants were diagnosed with depressive disorder (N = 44, 35.5%), and 29% (N = 36) of the participants were diagnosed with an anxiety disorder. About one-fourth of patients with NCD have cognitive impairment and 39.51% have psychiatric morbidity. Conclusions The prevalence of cognitive impairment is higher among patients of NCD with psychiatric morbidity. Patients with NCDs should be routinely screened for cognitive functioning and provided information about the development of cognitive impairment. Key messages Because of high prevalence of cognitive impairment and psychiatric morbidity in NCD patients, patients should be provided information to prevent it. There is a need to screen NCD patients routinely for cognitive functioning, and provide them information to prevent cognitive impairment.

The Contribution of Kidney Disease to Cognitive Impairment in Patients with Type 2 Diabetes.

This review focuses on the relationships between diabetes, cognitive impairment, and the contribution of kidney disease. We review the independent contributions of parameters of kidney disease, including albuminuria, glomerular filtration, bone/mineral metabolism, and vitamin D synthesis, on cognitive performance in patients with diabetes. Potential pathophysiologic mechanisms underlying these associations are discussed highlighting gaps in existing knowledge. Finally, effects of the dialysis procedure on the brain and cognitive performance are considered. Emphasis is placed on novel non-invasive screening tools with the potential to preserve cerebral perfusion during hemodialysis and limit cognitive decline in patients with diabetic ESKD. Patients with type 2 diabetes and advanced chronic kidney disease suffer a higher prevalence of cognitive impairment. This is particularly true in patients with diabetes and end-stage kidney disease (ESKD).

Natural History of Cognitive Impairment in Critical Illness Survivors. A Systematic Review.

Long-term cognitive impairment is common among ICU survivors, but its natural history remains unclear. In this systematic review, we report the frequency of cognitive impairment in ICU survivors across various time points after ICU discharge that were extracted from 46 of the 3,350 screened records. Prior studies used a range of cognitive instruments, including subjective assessments (10 studies), single or screening cognitive test such as Mini-Mental State Examination or Trail Making Tests A and B (23 studies), and comprehensive cognitive batteries (26 studies). The mean prevalence of cognitive impairment was higher with objective rather than subjective assessments (54% [95% confidence interval (CI), 51–57%] vs. 35% [95% CI, 29–41%] at 3 months after ICU discharge) and when comprehensive cognitive batteries rather than Mini-Mental State Examination were used (ICU discharge: 61% [95% CI, 38–100%] vs. 36% [95% CI, 15–63%]; 12 months after ICU discharge: 43% [95% CI, 10–78%] vs. 18% [95% CI, 10–20%]). Patients with acute respiratory distress syndrome had higher prevalence of cognitive impairment than mixed ICU patients at ICU discharge (82% [95% CI, 78–86%] vs. 48% [95% CI, 44–52%]). Although some studies repeated tests at more than one time point, the time intervals between tests were arbitrary and dictated by operational limitations of individual studies or chosen cognitive instruments. In summary, the prevalence and temporal trajectory of ICU-related cognitive impairment varies depending on the type of cognitive instrument used and the etiology of critical illness. Future studies should use modern comprehensive batteries to better delineate the natural history of cognitive recovery across ICU patient subgroups and determine which acute illness and treatment factors are associated with better recovery trajectories.

Neurophysiological mechanisms and perspective for the use of dual tasks inrecovering cognitive function after cardiac surgery

This review encompasses current trends regarding the use of dual tasks in recovering of cognitive functions in patients with ageassociated cognitive decline, traumatic brain injury and brain ischemia. The dual task represents a cognitive rehabilitation approach which implies the simultaneous execution of physical activity (walking, running or postural training) and cognitive tasks (internal counting, short-term memory and attention tasks, divergent tasks). Dual tasks with the simultaneous involvement of motor and cognitive functions are associated with specific features of brain activity and permit evaluation of the brain compensatory resources both in the normal state and in ageassociated cognitive decline or ischemic/ traumatic injury. The review also describes the basic neurophysiological mechanisms of the dual task-associated action on cognitive functions including transfer and interference. Performing of complex, multidirectional tasks provides a more efficient coordination of cognitive processes and improves the opportunities for successful cognitive functioning. The work underlines the high prevalence of cognitive impairment in cardiac surgery patients and shows the prospects of using dual tasks for the postoperative cognitive recovery. We assume that the rehabilitation using dual tasks involving brain areas providing executive control, working memory, attention and motor control can result in a pronounced cognitive recovery in cardiac surgery patients with cognitive impairment.

Factors influencing employment after minor stroke and NSTEMI

Aim: To study the effect of cognitive function, fatigue and emotional symptoms on employment after a minor ischemic stroke compared to non-ST-elevation myocardial infarction (NSTEMI).Material and methods: We included 217 patients with minor ischemic stroke and 133 NSTEMI patients employed at baseline aged 18–70 years. Minor stroke was defined as modified Rankin scale (mRS) 0–2 at day seven or at discharge if before. Included NSTEMI patients had the same functional mRS. We applied a selection of cognitive tests and the patients completed questionnaires measuring symptoms of anxiety, depression and fatigue at follow up. Stroke patients were tested at three and 12 months and NSTEMI at 12 months.Results: The patients still employed at 12 monthswere significantly younger than the unemployed patients and the NSTEMI patients employed were significantly older than the stroke patients (59 vs 55 years, p < .001). In total, 82 % of stroke patients and 90 % of the NSTEMI patients employed at baseline were still employed at 12 months (p = 06). Stroke patients at work after 12 months had higher education than unemployed patients. There were no difference between employed and unemployed patients in risk factors or location of cerebral ischemic lesions. Cognitive function did not change significantly in the stroke patients from three to 12 months. For stroke patients, we found a significant association between HADS-depression and unemployment at 12 months (p = 04), although this association was not present at three months. Lower age and higher educational level were associated with employment at 12 months for all patients.Discussion and conclusion: Age and education are the main factors influencing the ability to stay in work after a minor stroke. Employed stroke patients were younger than the NSTEMI patients, but there was no difference in the frequencies in remaining employed. The employment rate at 12 months was high despite the relatively high prevalence of cognitive impairment in both groups.

P1508COGNITIVE IMPAIRMENT A RISK FACTOR FOR NON ADHERENCE TO MEDICAL MANAGEMENT AMONG PATIENTS ON MAINTENANCE HEMODIALYSIS

Abstract Background and Aims Patients with chronic kidney disease (CKD) are at substantially higher risk for developing cognitive impairment (CI) compared with the general population. Subtle changes can impact engagement with healthcare, comprehension, decision-making, and medication adherence. The Montreal Cognitive Assessment (MoCA) test was reported to represent a suitable cognitive screening tool for hemodialysis patients. Our study aimed to assess the prevalence of CI in CKD patients undergoing hemodialysis, socio-demographic and patient-related variables affecting CI and relationship with medical adherence. Method Out of 65 patients in the HD unit, 58 patients (mean age 59.16±10.61 years old and meantime in therapy 6.93±5.03 years) accepted to participate in the study. The Montreal Cognitive Assessment (MoCA) scale was administered to patients. Patients with a MoCA global score 24/30 were considered cognitively impaired. Descriptive analysis was done for the socio-demographic and clinical variables. Results The mean total MoCA score for all the patients were 22.77679±3.8. Thirty seven patient 63.7% were evaluated with CI where 67.5 % with Mild CI (MCI) and 32.5% with severe CI (SCI) under 20 points). MoCA subscale analysis revealed that the mean score for visuospatial/executive domain and attention were the lowest with 5.38±1.3 /8max and 2.82±1.67/6 max and scores for orientation were the highest 5.94±0.59/6 max. MCI was related to vintage to dialysis (p &amp;lt; .00001) and education years (p&amp;lt;0.05) but not with age (p&amp;gt;0.05) and gender (p&amp;gt;0.05) where severe CI was related to age and comorbidity ( p&amp;lt;0.05 and P&amp;lt;0.01, respectively. We found a strong association between low scores and medical adherence (p&amp;lt;0.001). Conclusion: In hemodialysis, we have a relatively high prevalence of CI and screening for impairment should be considered in all adults with ESRD. Older age, vintage on dialysis, and comorbidity were associated with lower scores. The visuospatial/executive domain and attention were mostly affected. The association between low scores and medical adherence show a high risk for this group of patients.

The possible beneficial effects of higher vitamin B6 intake from diet on cognitive function of patients with neuromyelitis optica spectrum disorder

IntroductionGiven some evidence on the effects of vitamin B6 on cognitive function and the high prevalence of cognitive impairment in patients with Neuromyelitis Optica Spectrum Disorder (NMOSD), we conducted the present study to evaluate the correlation between dietary vitamin B6 intake and cognitive function among NMOSD patients. MethodA cross-sectional study was designed on 24 definite NMOSD patients in Sina hospital, Tehran, Iran. A validated 168-item food frequency questionnaire was used to obtain the participants’ routine dietary habits. For the cognitive function assessment, Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery was administered. Vitamin B6 intake per day was calculated, and the correlation between vitamin B6 and the results of MACFIMS subtests was examined. ResultsThe results revealed a positive correlation between dietary vitamin B6 intake and cognitive function in all subtests of MACFIMS. This direct correlation was significant in case of verbal and learning memory according to CVLT-II subtest (p-value:0.02; r:0.45) as well as speed of information processing and working memory according to SDMT subtest (p-value:0.04; r:0.43). The results from linear regression analysis adjusted for carbohydrate intake and disease duration indicated a significant ascending trend for the score of CVLT-II, SDMT, CVLT-II-delayed recall, and Brief Visuospatial Memory Test-Revised (BVMT-R) subtests through the quartiles of vitamin B6 intakes. ConclusionOur finding indicated a positive correlation between higher dietary intake of vitamin B6 and cognitive function of NMOSD patients. Based on high prevalence of cognitive malfunction in NMOSD patients, these results are promising.

High-Sensitivity Cardiac Troponin T and Cognitive Function in Patients With Ischemic Stroke.

Background and Purpose- Our study aim was to assess whether high-sensitivity cardiac troponin T (hs-cTnT), a specific biomarker for myocardial injury, is associated with cognitive function in patients after mild-to-moderate first-ever ischemic stroke. Methods- We used data from PROSCIS-B (Prospective Cohort With Incident Stroke Berlin). Cognitive function was assessed by Mini-Mental-State-Examination at baseline, and Telephone Interview for Cognitive Status-modified after 1 to 3 years of follow-up. Patients were categorized according to hs-cTnT quartiles. We performed generalized linear regression to calculate risk ratios of cognitive impairment (Mini-Mental-State-Examination <27; Telephone Interview for Cognitive Status-modified <32). Association of hs-cTnT with cognitive function over time was estimated using a linear mixed model. Results- We included 555 patients (mean age, 67 years, 62% male, median National Institutes of Health Stroke Scale 2 [interquartile range, 1-5], hs-cTnT above upper reference limit 40%, baseline cognitive impairment 28%). Baseline Mini-Mental-State-Examination score and rate of cognitive impairment were lower in patients in the highest versus lowest hs-cTnT quartile (median Mini-Mental-State-Examination 27 versus 29, and 15.3% versus 43.0%, adjusted risk ratio, 1.76 [95% CI, 1.07-2.90], respectively). If anything, cognition seemed to improve in all groups, yet Telephone Interview for Cognitive Status-modified scores were consistently lower in patients within the highest versus lowest hs-cTnT quartile (adjusted β, -1.33 [95% CI, -2.65 to -0.02]), without difference in the rate of change over time. Conclusions- In patients with mild-to-moderate first-ever ischemic stroke without dementia, higher hs-cTnT was associated with higher prevalence of cognitive impairment at baseline and lower Telephone Interview for Cognitive Status-modified during 3-year follow-up. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01363856.