Major Cognitive Disorder Research Articles

Using videos and films with people with major cognitive disorder living in care settings: A scoping review

Using videos and films with people with major cognitive disorder living in care settings: A scoping review

Subacute cognitive impairment after first-ever transient ischemic attack or ischemic stroke in young adults: The ODYSSEY study.

We aimed to investigate the prevalence of cognitive impairment in the subacute phase after transient ischemic attack (TIA) and ischemic stroke (IS), factors associated with a vascular cognitive disorder, and the prevalence of subjective cognitive complaints and their relation with objective cognitive performance. In this multicenter prospective cohort study, we recruited patients with first-ever TIA and IS, aged 18-49 years, between 2013 and 2021 for cognitive assessment up to 6 months after index event. We calculated composite Z-scores for seven cognitive domains. We defined cognitive impairment as a composite Z-score < -1.5. We defined major vascular cognitive disorder as a Z-score < -2.0 in one or more cognitive domains. Fifty three TIA and 545 IS patients completed cognitive assessment with mean time to assessment of 89.7 (SD 40.7) days. The median NIHSS at admission was 3 (interquartile range, 1-5). Cognitive impairment was common in five domains (up to 37%), with similar proportion in TIA and IS patients. Patients with major vascular cognitive disorder had a lower education level, higher NIHSS scores and more frequent lesions in the left frontotemporal lobe than without vascular cognitive disorder (p < 0.05 FDR-corrected). Subjective memory and executive cognitive complaints were present in about two-thirds of the patients, but were weakly associated with objective cognitive performance (β: -0.32 and -0.21, respectively). In the subacute phase after TIA or stroke in young adults, cognitive impairment and subjective cognitive complaints are prevalent, but they are weakly associated with each other.

Cognitive profile in hypertensive patients. Usefulness of the Clock Drawing Test

Hypertension is the main cause of cognitive impairment and the executive dysfunction the most com- mon cognitive domain affected. The aims of this research have been to characterize the cognitive profiles (s) in hypertensive patients and to identify the most usefulness Test (s) in the routine clinical practice to identify them. We assessed the cognitive status in 69 hypertensive patients who were administered a battery of cognitive Tests that included the MMSE, the Mini-Boston Naming Test, verbal fluency and the Clock drawing Test. The average of the sample was 72.2±10.1 years. The Clock-drawing Test and the Mini-Boston Naming Test differentiated 3 cognitive profiles: no cognitive impairment, minor cognitive disorder and major cognitive disorder. A strong association was observed between the semantic (0.87) and executive (0.75) components of the Clock-drawing Test with the Mini-Boston Naming Test (0.96). The analysis of clusters and switchings in the verbal fluency Test differentiated the severe forms of cognitive impairment. The results obtained confirm the value of the Clock-drawing Test to identify the different cognitive profiles in hypertensive patients, becoming a valid screening test to be used in routine clinical practice and a potential biomarker of cognitive dysfunction in hypertensive patients.

The Sound of Music: Short-term Effects of Live Music Performance on the Cognitive and Emotional Statuses of Residential Patients with Major Neurocognitive Disorder

<h3>Introduction</h3> Patientswith neurocognitive disorders (NCD) commonly experience a range of psychiatric symptoms such as depression, anxiety, psychosis, and agitation.¹ These comorbidities complicate the course of treatment for these patients as well as exacerbate caregiver burden. Since pharmacologic interventions are known to pose significant risks to these patients, there is great urgency to find additional non-pharmacologic options to improve quality of care.¹ Music therapy is becoming a more frequently used tool in different treatment settings and has been shown to improve anxiety and depression, however intensive and structured music therapy can also be a cost burden for residential facilities.^2,3 This study's aim was to assess the short-term benefits of a live music performance for residential patients with mild and moderate major NCD. <h3>Methods</h3> Thisis a prospective, non-blinded, longitudinal comparison study. Inclusion criteria were age 65-100, English speaking, and had either a diagnosis of major NCD, cognitive disorder, or dementia of the mild to moderate stage that required institutionalization at a residential facility. Exclusion criteria were severe presbycusis, and diagnosis of dementia or NCD of the severe stage. Participating residential facilities with connections to the Symphony of Soul Foundation and St. David's Foundation were asked to publicize this study to residents and their legally authorized representatives (LAR). The participants would then provide informed assent and consent, respectively, to enroll. The study intervention was a 30 minute live-performance of a set list of popular music from the 1930s-1950s (English language), given by a standard performer. The main statistical analysis will be a multivariate repeated measures comparison of scores that assess cognition, depression, and quality of life using the Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), and the Cornell-Brown Scale for Quality of Life (CBSQoL). The scales were administered 1 week before the study intervention to participating subjects for baseline scores, and then re-administered 1 week after the intervention. Different versions of the MoCA (v.1 and v.2) were used for the pre- and post-intervention assessments. <h3>Results</h3> Atotal of 8 subjects (n=8) and their respective LARs provided assent and consent to participate in the study. There was 1 complete dropout before the study began. The mean MoCA score pre-intervention, MoCA_pre = 7.3, with a 95% CI = [2.36, 12.25]; the mean MoCA score post-intervention, MoCA_post = 9.4, with a 95% CI = [3.41, 15.39]; the difference between the two mean MoCA scores was not statistically significant, since the 95% CI for this difference was [-5.65, 9.85]. Subjects did not have scores that indicated clinical depression throughout the study, with a mean GDS_pre = 1.5, and a mean GDS_post = 2.2. The mean CBSQoL_pre = -3.67, with a 95% CI = [-10.91, 3.57]; the mean CBSQoL_post = 17, with a 95% CI = [10.86, 23.14]; the CBSQoL scores between the two groups had statistically significant difference as evident in non-overlapping CIs; the 95% CI for the difference between the two mean CBSQoL scores was [11.19, 30.15]. <h3>Conclusions</h3> Thisstudy's initial results suggested that there was a statistically significant improvement in the subjects' quality of life after a brief, live-musical performance. However there were no significant differences in the subjects' cognition and mood. The labor intensity behind completing the pre- and post- intervention assessments was a notable barrier for subjects to participate effectively, and was also a deterrent for other eligible subjects to enroll in the study. Decreasing the difficulty for subjects to participate in the future (e.g., through optimizing the testing environment, shortening the music performance) might therefore increase the sample size and improve the study's power and validity.

The Development and Validation of Simplified Machine Learning Algorithms to Predict Prognosis of Hospitalized Patients With COVID-19: Multicenter, Retrospective Study.

BackgroundThe current COVID-19 pandemic is unprecedented; under resource-constrained settings, predictive algorithms can help to stratify disease severity, alerting physicians of high-risk patients; however, there are only few risk scores derived from a substantially large electronic health record (EHR) data set, using simplified predictors as input.ObjectiveThe objectives of this study were to develop and validate simplified machine learning algorithms that predict COVID-19 adverse outcomes; to evaluate the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and calibration of the algorithms; and to derive clinically meaningful thresholds.MethodsWe performed machine learning model development and validation via a cohort study using multicenter, patient-level, longitudinal EHRs from the Optum COVID-19 database that provides anonymized, longitudinal EHR from across the United States. The models were developed based on clinical characteristics to predict 28-day in-hospital mortality, intensive care unit (ICU) admission, respiratory failure, and mechanical ventilator usages at inpatient setting. Data from patients who were admitted from February 1, 2020, to September 7, 2020, were randomly sampled into development, validation, and test data sets; data collected from September 7, 2020, to November 15, 2020, were reserved as the postdevelopment prospective test data set.ResultsOf the 3.7 million patients in the analysis, 585,867 patients were diagnosed or tested positive for SARS-CoV-2, and 50,703 adult patients were hospitalized with COVID-19 between February 1 and November 15, 2020. Among the study cohort (n=50,703), there were 6204 deaths, 9564 ICU admissions, 6478 mechanically ventilated or EMCO patients, and 25,169 patients developed acute respiratory distress syndrome or respiratory failure within 28 days since hospital admission. The algorithms demonstrated high accuracy (AUC 0.89, 95% CI 0.89-0.89 on the test data set [n=10,752]), consistent prediction through the second wave of the pandemic from September to November (AUC 0.85, 95% CI 0.85-0.86) on the postdevelopment prospective test data set [n=14,863], great clinical relevance, and utility. Besides, a comprehensive set of 386 input covariates from baseline or at admission were included in the analysis; the end-to-end pipeline automates feature selection and model development. The parsimonious model with only 10 input predictors produced comparably accurate predictions; these 10 predictors (age, blood urea nitrogen, SpO2, systolic and diastolic blood pressures, respiration rate, pulse, temperature, albumin, and major cognitive disorder excluding stroke) are commonly measured and concordant with recognized risk factors for COVID-19.ConclusionsThe systematic approach and rigorous validation demonstrate consistent model performance to predict even beyond the period of data collection, with satisfactory discriminatory power and great clinical utility. Overall, the study offers an accurate, validated, and reliable prediction model based on only 10 clinical features as a prognostic tool to stratifying patients with COVID-19 into intermediate-, high-, and very high-risk groups. This simple predictive tool is shared with a wider health care community, to enable service as an early warning system to alert physicians of possible high-risk patients, or as a resource triaging tool to optimize health care resources.

Morphometric analysis of hippocampus and intracranial formations based on their stages in patients diagnosed with major cognitive disorder.

Alzheimer's disease (AD) is a major cognitive disorder classified as a common type of dementia. Magnetic resonance imaging (MRI) is the most practical method for diagnostic purposes in AD. The aim of the study was to determine the volume of the hippocampus and intracranial structures in AD using MRI. A total of 102 patients with AD were classified based on the mini mental test scores as early, moderate, and advanced stage. The control group included 35 healthy subjects. MRI were compared between the patients and control groups based on the calculations made utilizing volBrain software. Intracranial volumetric parameters were also compared between the three stages of AD. The white matter volumes, total hippocampus, total cerebrum, right cerebrum, left cerebrum, truncus encephalic, total nucleus caudatus and total corpus amygdaloideum were significantly increased in the AD. The white matter volumes, right hippocampus, left hippocampus, total cerebrum, left cerebrum, and right cerebellum were significantly increased in the patients in the early stage compared to the patients in the advanced stage AD. The most efficient volumetric study in AD could be performed by obtaining long-term periodic morphometric data of an early diagnosed and regularly followed-up patient population.

Associations among clinical characteristics of sleep quality, cognitive performance, and brain architecture in Thai dementia spectrum disorders

AbstractBackgroundSleep disorders are increased with advancing age. Poor sleep quality is a risk factor for cognitive decline and dementia. We aimed 1) to explore the relationship between sleep quality, sleep architecture and cognition; 2) to investigate the association between brain volume and sleep parameters.MethodA total of 95 participants (70 female, mean age 67.18 ± 10 years) were included in this study. Thirty were those with major cognitive disorder patients, twenty‐five individuals had mild cognitive impairment (MCI), and forty were normal controls. Sleep parameters were measured using wrist actigraphy and subjective sleep questioners. The participants were evaluated with high‐resolution MRI. Three Dimensional sequences on Free‐Surfer morphometric procedure was used as the automated segmentation method to obtain brain volume. Demographic data, medical history, sleep characteristics, neuropsychological and mood evaluation were collected from participants.ResultMCI patients had significantly lower sleep efficiency than cognitive healthy persons, 81.30 + 7 .39 % vs. 85.12 + 5.09 %, p=0.04. 66 % of the participants had poor sleep quality. Prevalence of probable REM sleep behavior disorder (RBD) and restless leg syndrome was high in dementia group. Longer sleep latency was associated with worse performance on global cognition. Total sleep time was associated with entorhinal corex volume and hippocampal volume. Sleep latency was associated with hippocampal volumeConclusionSleep disorders were common in both cognitively healthy persons and dementia spectrum disorders. Lower sleep quality and disturbance of sleep maintenance were associated with the development of cognitive impairment. The causes and the consequences of poor sleep quality in patients with dementia spectrum disorders needed to be explored.

Morphometric Analysis of Hippocampus and Intracranial Formations Based on Their Stages in Patients Diagnosed with Major Cognitive Disorder

Morphometric Analysis of Hippocampus and Intracranial Formations Based on Their Stages in Patients Diagnosed with Major Cognitive Disorder

A Neural Substrate for Mirror Agnosia and Mirror Image Agnosia - Is it a Network disorder?

Reflected image processing is a unique brain function and its abnormalities result in problems of localizing, recognizing the images, and utilizing this information in everyday life. The aim of this study was to characterize clinical and neuropsychological profiles and to identify the probable neural substrate for this phenomenon in major cognitive disorder. We conducted a prospective study from February 2015 to May 2017 in patients with Major Cognitive Disorder (MCD, DSM-5 criteria). All patients were tested for problems in reflected image processing using the detailed protocol after ethical approval of the institute and consent. They also underwent a detailed neuropsychological evaluation, biochemical tests and neuroimaging (structural, diffusion, and resting-state functional MRI) as per established protocol. Of the 18 patients, 11 had mirror agnosia (MA), 5 had mirror image agnosia (MIA) and 2 had both. MRI of MA patients showed parietal atrophy and whereas diffuse pattern of atrophy was seen with MIA. In the MA group, the left superior longitudinal fasciculus showed significantly greater fractional anisotropy and the left angular gyrus showed increased functional connectivity with left anterior cingulate, left dorsolateral prefrontal and bilateral posterior cingulate regions. Mirror image processing defects were not related to the type of MCD, severity or pattern of neuropsychological dysfunction. There are structural and functional alterations in localized regions as well as both hemispheres. Therefore, it is more likely to be a network disorder, irrespective of the MCD type or severity.

A new method for classification of subjects with major cognitive disorder, Alzheimer type, based on electroencephalographic biomarkers

1 Abstract The diagnosis of Alzheimer's disease (AD), Mild Cognitive Impairment (MCI), and healthy subjects (Healthy) in clinical practice currently lacks an automated tool. Discriminating between Healthy and MCI subjects requires experienced neuropsychologists and have a sensitivity of 80%. In this paper, a new classification method to separate the three groups using EEG resting-state is evaluated. The method integrates features as wavelet entropy's Pearson correlation coefficient, theta relative power and P300 latency and amplitude. The use of Pearson correlation to analyze wavelet entropy is a new approach since entropy analysis is traditionally based on the average of entropy values of all epochs. The biomarkers integration is also novel since, to our knowledge, there are no proposed methods combining connectivity, spectral characteristics, complexity and P300 for this task. The results obtained show that it is possible to automatically classify a subject with an overall accuracy of 94.44%, close to the best result found in the literature, 97.90%. The classification method here proposed could be the base for implementing a quantitative diagnosis-support tool. The selected features also may be used as endogenous indicators of progression from MCI to AD.

Cognitive and legal aspects in older people

In Chile, 7.1% of people aged over 60 years have some type of cognitive disorder. The frequency of the latter increases to 13% in people between 75-79 years and 36.2% in people over 85 years. The concept of mild cognitive impairment (MCI) and dementia have evolved over time. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) uses the term minor and major neurocognitive disorder, replacing the DCL and dementia respectively. Major cognitive disorder impairs functional performance while minor disorders does not. There is an arbitrary discrimination against the elderly. A form of discrimination is the request made by some notaries of a medical certification of the cognitive function for older people willing to carry out a legal procedure. This request has the sole effect of pre-establishing evidence in favor of the notary and not protecting the testator or the vulnerable person. Assessing the ability of older people to care for themselves and their possessions has important implications for them and their families, since there is a serious risk of prejudice when someone is declared as disabled. Thus, considering the epidemiology of cognitive disorders in our country we propose a series of legal and medical discussion points aimed to protect autonomy and to protect individuals and their possessions when they have difficulties to control their decisions.

THE SOUND OF MUSIC: SHORT-TERM EFFECTS OF LIVE MUSIC PERFORMANCE ON THE COGNITIVE AND EMOTIONAL STATUSES OF RESIDENTIAL PATIENTS WITH MAJOR NEUROCOGNITIVE DISORDER

Introduction Patients with neurocognitive disorders (NCD) commonly experience a range of psychiatric symptoms such as depression, anxiety, psychosis, and agitation. 1 These comorbidities complicate the course of treatment for these patients as well as exacerbate caregiver burden. Since pharmacologic interventions are known to pose significant risks to these patients, there is great urgency to find additional non-pharmacologic options to improve quality of care. 1 Music therapy is becoming a more frequently used tool in different treatment settings and has been shown to improve anxiety and depression, however intensive and structured music therapy can also be a cost burden for residential facilities. 2 , 3 This study's aim was to assess the short-term benefits of a live music performance for residential patients with mild and moderate major NCD. Methods This is a prospective, non-blinded, longitudinal comparison study. Inclusion criteria were age 65-100, English speaking, and had either a diagnosis of major NCD, cognitive disorder, or dementia of the mild to moderate stage that required institutionalization at a residential facility. Exclusion criteria were severe presbycusis, and diagnosis of dementia or NCD of the severe stage. Participating residential facilities with connections to the Symphony of Soul Foundation and St. David's Foundation were asked to publicize this study to residents and their legally authorized representatives (LAR). The participants would then provide informed assent and consent, respectively, to enroll. The study intervention was a 30 minute live-performance of a set list of popular music from the 1930s-1950s (English language), given by a standard performer. The main statistical analysis will be a multivariate repeated measures comparison of scores that assess cognition, depression, and quality of life using the Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), and the Cornell-Brown Scale for Quality of Life (CBSQoL). The scales were administered 1 week before the study intervention to participating subjects for baseline scores, and then re-administered 1 week after the intervention. Different versions of the MoCA (v.1 and v.2) were used for the pre- and post-intervention assessments. Results A total of 8 subjects (n=8) and their respective LARs provided assent and consent to participate in the study. There was 1 complete dropout before the study began. The mean MoCA score pre-intervention, MoCApre = 7.3, with a 95% CI = [2.36, 12.25]; the mean MoCA score post-intervention, MoCApost = 9.4, with a 95% CI = [3.41, 15.39]; the difference between the two mean MoCA scores was not statistically significant, since the 95% CI for this difference was [-5.65, 9.85]. Subjects did not have scores that indicated clinical depression throughout the study, with a mean GDSpre = 1.5, and a mean GDSpost = 2.2. The mean CBSQoLpre = -3.67, with a 95% CI = [-10.91, 3.57]; the mean CBSQoLpost = 17, with a 95% CI = [10.86, 23.14]; the CBSQoL scores between the two groups had statistically significant difference as evident in non-overlapping CIs; the 95% CI for the difference between the two mean CBSQoL scores was [11.19, 30.15]. Conclusions This study's initial results suggested that there was a statistically significant improvement in the subjects’ quality of life after a brief, live-musical performance. However there were no significant differences in the subjects’ cognition and mood. The labor intensity that was required for the subjects to complete the pre- and post- intervention assessments was a notable barrier for them to participate effectively as evident by the dropout rate, and was also a deterrent for additional eligible subjects to enroll in the study. Decreasing the difficulty for subjects to participate in the future (e.g., through optimizing the testing environment, shortening the music performance) might therefore increase the sample size and improve the study's power and validity This research was funded by: Symphony of Soul Foundation, St. David's Foundation

Performance-based assessment of telephone use in three patients with a major cognitive disorder

Performance-based assessment of telephone use in three patients with a major cognitive disorder

Cerebral Lipid Dynamics in Chronic Cerebral Hypoperfusion Model by DESI-MS Imaging

Vascular dementia (VD) is a major cognitive disorder originated from a blood flow disruption in the brain. This process leads to chronic cerebral ischemia that deeply affects neuronal tissues and lipid homeostasis. The understanding of cerebral lipid dynamics during chronic ischemia can reveal biomarkers and novel pharmacological targets for the treatment of VD. In this study, we used the Desorption Electrospray Ionization – imaging mass spectrometry (DESI–IMS) technique to map lipids in the rat brain tissues after bilateral common carotid artery occlusion (BCCAO) rat model of chronic cerebral hypoperfusion. The brain imaging enabled the detection of differences in lipids from ischemic and non-ischemic brains. The analysis demonstrated that arachidonic acid (ARA), docosahexaenoic acid (DHA), dihomo-γ-linolenic acid, hydroxyeicosatetraenoic (HETE)-Ala and glycerophosphoethanolamine levels were significantly reduced in the hippocampus and cortex of animals submitted to BCCAO model when compared to control animals. Decanoic acid was increased after 30 days of BCCAO model. Partial least squares discriminant analysis (PLS-DA) could discriminate between BCCAO group and the control group, in which γ-linolenic acid (m/z 277) ion and stearic acid (m/z 283) had the highest discrimination potential. Taken together, these findings indicate that lipid dynamics are altered in chronic ischemia-induced by BCCAO in rats and indicate potential biomarkers and pharmacological targets for VD.

The Diagnostic Value Of Mattis Dementia Rating Scale- Initiation Perseveration Subscale In Vascular Cognitive Disorders

Vascular cognitive disorder (VCD)2 comprises a heterogeneous group of cerebrovascular disorders, leading to a continuum of cognitive impairment, ranging from the level of mild cognitive impairment or mild vascular cognitive disorder (VCDM) to full-blown vascular dementia or major vascular cognitive disorder (VCDD).

Cognitive aging of bipolar patients

Bipolar disorder is a severe, recurrent mood disorder, associated with a higher rate of morbidity and mortality. A new population of aging bipolar patients is emerging for which specific studies are scarce. There seem to be an association between bipolar disorder and major cognitive disorder, significantly affecting patients' psychosocial outcomes. Though the neuropathological mecanisms underlying such an evolution have yet to be found, there are three paradigms that can help us understand the clinical heterogeneity within the aging bipolar group. First, there seem to be different cognitive endophenotypes within the bipolar spectrum, related to different neurodevelopmental abnormalities. Each of these endophenotypes will interact with the normal cognitive aging process which is associated with a decline in certain cognitive domains while others remain stable. Nevertheless this cognitive decline will be variable from one patient to another. This can be explained by cognitive reserve which reflects the brain's capacity to endure neuropathology, and minimize clinical manifestations. The second hypothesis is the neuroprogression paradigm that offers an explanation on how a cyclic disorder such as bipolar disorder could evolve progressively into a major cognitive disorder. According to this paradigm, each manic and depressive episode is associated to an allostatic load, a systemic response associated with the secretion of neuroinflammatory factors which will secondarily alter the brain's connectivity. The third paradigm suggests that bipolar patients may develop either vascular dementia which is coherent with their increased vascular risk factor or another neurodegenerative disease. All three paradigms are not exclusive, and many other factors are to be taken into account such as medication, sensory impairment, health related changes and residual mood symptoms, which can alter cognitive functions.

Preserved intellectual functioning in Korsakoff’s syndrome? Actual and premorbid intelligence in patients with major or mild alcohol-related cognitive disorder

ABSTRACTObjective: Although alcoholic Korsakoff patients show profound cognitive impairments (including amnesia), intellectual function has typically been assumed to be preserved. Based on more recent models on intelligence, however, it can be hypothesized that although preserved verbal or crystallized abilities may be expected in Korsakoff patients, fluid reasoning may be significantly reduced. Aim of this study was to gain insight in intelligence profiles of patients with alcohol-related cognitive disorders with and without Korsakoff’s syndrome (KS).Method: Test performance on the Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV) and the National Adult Reading Test (NART) was assessed in 34 patients diagnosed with KS, 40 patients with chronic alcohol-related cognitive disorder without Korsakoff’s syndrome (ALC), and 47 non-alcoholic psychiatric controls (non-ALC).Results: Analysis revealed significant lower WAIS-IV Full-Scale IQ scores compared to the estimated premorbid NART-IQ in both groups with alcohol-related cognitive disorders (KS and ALC). With respect to the index scores, KS patients performed worse than non-ALC patients on the Perceptual Reasoning and Processing Speed Indices. Performance on the Verbal Comprehension and Working Memory Indices did not differ between groups.Conclusion: Not all aspects of intelligence are preserved in Korsakoff’s syndrome and implications of assessment of intellectual function in patients with alcohol-use disorder are discussed.

Pattern of referral to a consultation-liaison psychiatry service in an Egyptian cancer center

Aim/Objective/Background Integration of consultation-liaison(C-L) psychiatry services in palliative care units in oncology departments is very limited in Egypt. A new dedicated C-L psychiatry service was recently established within the premises of the palliative care clinic in Kasr al Ainy Center for Clinical Oncology and Nuclear Medicine (NEMROCK), Cairo, Egypt. The aim of this study was to examine the characteristics, diagnoses and follow up of patients referred to this new service in a year period. Methods The clinical and psychiatric characteristics of all consecutive oncology patients (n=44) referred to this new C-L psychiatric service in a year period were examined. Psychiatric diagnosis was made according to the Diagnostic and Statistical Manual of Psychiatric Disorders, 5th edition (DSM 5). Results A total number of 44 patients (12 males and 32 females) were referred to the C-L clinic during the study period. Half of the patients had breast cancer.The other half was a diverse group involving different sites. In the advanced stage of cancer, males were significantly more represented than the females. As regards psychiatric diagnosis, the most common category was adjustment disorder (22 patients) followed by major depression (11 patients). Six of the patients had non-psychiatric distress, two had a primary psychotic disorder, two had substance related disorder and one had a major cognitive disorder. Causes of suffering in the non-psychiatric distressed group included lack of adequate medical information, physical concerns, existential concerns and family concerns. Most patients received psychotropic medication. Conclusions The scope and severity of psychiatric morbidity and distress detected in the referred oncology patients reflects the need to integrate C-L psychiatric services within psycho-oncological and palliative care clinics.

An Interview With Addiction Psychiatrist Dr. Christoffel Le Roux

An Interview With Addiction Psychiatrist Dr. Christoffel Le Roux

A Role for New Brain Magnetic Resonance Imaging Modalities in Daily Clinical Practice: Protocol of the Prediction of Cognitive Recovery After Stroke (PROCRAS) Study.

BackgroundCognitive impairment is common after acute ischemic stroke, affecting up to 75% of the patients. About half of the patients will show recovery, whereas the others will remain cognitively impaired or deteriorate. It is difficult to predict these different cognitive outcomes.ObjectiveThe objective of this study is to investigate whether diffusion tensor imaging–based measures of brain connectivity predict cognitive recovery after 1 year, in addition to patient characteristics and stroke severity. A specific premise of the Prediction of Cognitive Recovery After Stroke (PROCRAS) study is that it is conducted in a daily practice setting.MethodsThe PROCRAS study is a prospective, mono-center cohort study conducted in a large teaching hospital in the Netherlands. A total of 350 patients suffering from an ischemic stroke who screen positive for cognitive impairment on the Montreal Cognitive Assessment (MoCA<26) in the acute stage will undergo a 3Tesla-Magnetic Resonance Imaging (3T-MRI) with a diffusion-weighted sequence and a neuropsychological assessment. Patients will be classified as being unimpaired, as having a mild vascular cognitive disorder, or as having a major vascular cognitive disorder. One year after stroke, patients will undergo follow-up neuropsychological assessment. The primary endpoint is recovery of cognitive function 1 year after stroke in patients with a confirmed poststroke cognitive disorder. The secondary endpoint is deterioration of cognitive function in the first year after stroke.ResultsThe study is already ongoing for 1.5 years, and thus far, 252 patients have provided written informed consent. Final results are expected in June 2019.ConclusionsThe PROCRAS study will show the additional predictive value of diffusion tensor imaging-based measures of brain connectivity for cognitive outcome at 1 year in patients with a poststroke cognitive disorder in a daily clinical practice setting.Registered Report IdentifierRR1-10.2196/9431