Management Of Neurocognitive Disorders Research Articles

Postoperative Delirium and Neurocognitive Disorders: A Comprehensive Review of Pathophysiology, Risk Factors, and Management Strategies.

Postoperative delirium (POD) and neurocognitive disorders (NCDs) are common and serious complications that can occur after surgery, particularly in older adults and those with preexisting cognitive impairments. These conditions are associated with significant morbidity, increased healthcare costs, and reduced quality of life. Understanding the underlying mechanisms, risk factors, and effective management strategies for POD and NCDs is critical for improving patient outcomes and reducing the burden on healthcare systems. This comprehensive review aims to synthesize current knowledge on the pathophysiology, risk factors, and management strategies for POD and NCDs. It explores the neurobiological and molecular mechanisms contributing to these conditions, identifies the patient-related, surgical, and environmental factors that increase risk, and evaluates pharmacological and non-pharmacological approaches to prevention and treatment. A thorough literature review was conducted using recent studies, clinical guidelines, and expert consensus to provide a detailed overview of the pathophysiology, risk factors, clinical presentation, prevention, and management of POD and NCDs. The pathophysiology of POD and NCDs involves complex interactions between neuroinflammatory processes, neurotransmitter imbalances, and brain network disruptions. Risk factors include advanced age, preexisting cognitive impairment, type and duration of surgery, and perioperative complications. Management strategies emphasize a multidisciplinary approach, incorporating preoperative optimization, careful intraoperative management, and postoperative interventions. Pharmacological treatments, such as antipsychotics, and non-pharmacological approaches, including environmental modifications and cognitive rehabilitation, play crucial roles in management. Postoperative delirium and NCDs are multifactorial conditions with significant impacts on surgical outcomes. Effective management requires a comprehensive understanding of their pathophysiology and risk factors and the implementation of targeted prevention and treatment strategies. Future research should focus on personalized approaches to prevention and treatment, further elucidation of mechanisms, and developing predictive models to enhance care for patients at risk of these neurocognitive complications.

Choroidal Morphological Changes: A Promising Avenue for Early Diagnosis of Neurocognitive Disorders

Neurocognitive Disorders (NCDs) pose a substantial public health challenge, demanding timely detection and intervention to enhance patient outcomes. Recent strides in medical imaging have unveiled choroidal morphological alterations as a novel avenue for early NCD diagnosis. This study investigates the effectiveness of deep learning algorithms, particularly Residual neural networks (ResNet) and Visual Geometry Group 19 (VGG19) architectures, in analyzing choroidal images to identify subtle morphological changes indicative of underlying neurodegenerative processes. A comprehensive dataset encompassing choroidal images from individuals with NCDs and healthy controls was employed for model training and evaluation. Among the architectures assessed, ResNet152 exhibited superior performance, achieving an impressive area under the curve (AUC) of 0.97 in distinguishing between NCD patients and healthy individuals. The findings suggest that choroidal morphological changes hold promise as a potential biomarker for early NCD detection and monitoring. Integration of deep learning-based choroidal morphology analysis into clinical practice has the potential to enhance early intervention strategies, thereby contributing to improved patient outcomes in neurocognitive disorders. This research underscores the importance of exploring innovative approaches for early diagnosis and management of NCDs, aiming to enhance the quality of life for affected individuals and alleviate the societal burden associated with these disorders. Further studies are warranted to validate the utility of choroidal morphology analysis in clinical settings and to elucidate its role in the broader context of NCD diagnosis and management.

Development and validation of prediction models for neurocognitive disorders in adult patients admitted to the ICU with sleep disturbance.

BackgroundNeurocognitive disorders (NCDs) and sleep disturbance are highly prevalent in the perioperative period and intensive care unit (ICU). There has been a lack of individualized evaluation tools designed for the high‐risk NCDs in critically ill patients with sleep disturbance.ObjectivesThe aim of this study was to develop and validate prediction models for NCDs among adult patients with sleep disturbance.MethodsThe R software was used to analyze the dataset of adult patients admitted to the ICU with sleep disturbance, who were diagnosed following the codes of the International Classification of Diseases, 9th Revision (ICD‐9) and 10th Revision (ICD‐10) using the MIMIC‐IV database. We used logistic regression and LASSO analyses to identify important risk factors associated with NCDs and develop nomograms for NCDs predictions. We measured the performances of the nomograms using the bootstrap resampling procedure, sensitivity, specificity of the receiver operating characteristic (ROC), area under the ROC curves (AUC), and decision curve analysis (DCA).ResultsThe prediction models shared the 10 risk factors (age, gender, midazolam, morphine, glucose, diabetes diseases, potassium, international normalized ratio, partial thromboplastin time, and respiratory rate). Cardiovascular diseases were included in the logistic regression, the sensitivity was 74.1%, and specificity was 64.6%. When platelet and Glasgow Coma Score (GCS) were included and cardiovascular diseases were removed in the LASSO prediction model, the sensitivity was 86.1% and specificity was 82.8%. Discriminative abilities of the logistic prediction and LASSO prediction models for NCDs in the validation set were evaluated as the AUC scores, which were 0.730 (95% CI 0.716–0.743) and 0.920 (95% CI 0.912–0.927). Net benefits of the prediction models were observed at threshold probabilities of 0.567 and 0.914.ConclusionsThe LASSO prediction model showed better performance than the logistic prediction model and should be preferred for nomogram‐assisted decisions on clinical risk management of NCDs among adult patients with sleep disturbance in the ICU.

Postoperative delirium and neurocognitive disorders.

Postoperative neurocognitive disorders (NCD) are significant causes of morbidity and mortality. In this paper, we will review our understanding and potential management of postoperative NCD. Postoperative delirium, delayed neurocognitive recovery and postoperative cognitive dysfunction (POCD) are recognized as a part of the continuous spectrum of postoperative NCD. Although the pathophysiology is still poorly understood, there is renewed focus on improving neurocognitive outcomes of aging surgical population. Novel methods of neurocognitive screening are developed and research in the prevention and management of NCD has gained traction. A spectrum of NCD exists in surgical patients ranging from postoperative delirium, delayed neurocognitive recovery, and POCD. Identification of patients at-risk for developing NCD can help target appropriate perioperative intervention. Also, specialized care teams and the implementation of standardized protocols are crucial for the successful management perioperative NCD. Finally, large, randomized, multicenter studies are needed to confirm benefits of preventive and treatment strategies.

Impact of the Quebec Alzheimer Plan on the detection and management of Alzheimer disease and other neurocognitive disorders in primary health care: a retrospective study.

The Quebec Alzheimer Plan aims to improve care provided to patients with neurocognitive disorders in Family Medicine Groups (FMGs) (multidisciplinary team-based primary care practices). The objective of this study was to determine changes in the detection and management of neurocognitive disorders following implementation of the plan, in 2014. This was a retrospective chart review before and after implementation of the Quebec Alzheimer Plan in 13 FMGs. We reviewed 1919 randomly selected charts of patients aged 75 years or more and 945 randomly selected charts of patients in this age group with neurocognitive disorders. In the first group, selected outcomes were proportion of patients with documentation of cognitive status, documented diagnosis of neurocognitive disorder, documented cognitive testing and referral to a memory clinic. In patients with neurocognitive disorders, the outcomes were number of contacts with an FMG, quality of follow-up score (documented assessments in 10 domains: cognitive testing, functional status, behavioural and psychological symptoms of dementia, weight, caregiver needs, driving status, home care needs, community service needs, absence of anticholinergic medication and management of dementia medications) and proportion referred to a memory clinic. Significantly more patients aged 75 or more had documentation of cognitive status in their chart after plan implementation than before implementation (440 [45.1%] v. 351 [37.2%]) (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.18-1.81). No significant changes were found in documented diagnosis of neurocognitive disorders, cognitive testing or referral to a memory clinic. Among patients with neurocognitive disorders, the number of contacts with an FMG (adjusted mean difference 1.6, 95% CI 0.3-2.8) and quality of follow-up score (adjusted mean difference 6.6, 95% CI 3.9-9.2) increased significantly, without significant changes in the number of referrals to a memory clinic. The results suggest that the Quebec Alzheimer Plan is feasible and beneficial in terms of detection and management of neurocognitive disorders, without an increase in referral to specialists. The findings will be used to scale up the Quebec Alzheimer Plan and to develop the Canadian federal dementia strategy.

An approach with serious exergames for assessment and stimulation of patients with neurocognitive disorders

We present a clinical and therapeutic approach aiming to create new care for patients with neurocognitive disorders (NCD). Enriched environment including physical and cognitive stimulation improves cognitive functions 1. The aim of this paper is to describe a method for non-pharmacological management of NCD using serious exergames (SEG). SEG are serious video games integrating physical activity. We propose to use SEG as a tool to provide enriched environment associating physical activity and cognitive stimulation.

Velocidad de marcha y desarrollo de trastornos neurocognitivos en adultos mayores: resultados de una cohorte peruana

IntroductionThe prevention and management of neurocognitive disorders (NCD) among older adults can be improved by early identification of risk factors such as walking speed. The objective of the study is to assess the association between gait speed and NCD onset in a population of Peruvian older adults. Material and methodsCohort conducted in older adults who attended the geriatrics service of Naval Medical Center (Callao, Peru). During the baseline assessment, participants’ gait speed was recorded. Subsequently, participants were followed-up annually for 5 years, with a mean of 21 months. NCD onset was defined as the occurrence of a score ≤24 points on the Mini Mental State Examination (screening test) during follow-up. The hazard ratios (HR) and their 95% confidence intervals (95% CI) were calculated using Cox regression. ResultsThe study included 657 participants, with a mean age of 73.4±9.2 (SD) years, of whom 47.0% were male, 47.8% had a gait speed <0.8 m/s, and 20.1% developed NCD during the follow up. It was found that older adults who had gait speed <0.8 m/s at baseline were more likely to develop NCD than those who had a gait speed ≥0.8 m/s (adjusted HR=1.41, 95% CI=1.34-1.47). ConclusionA longitudinal association was found between decreased gait speed and NCD onset, suggesting that gait speed could be useful to identify patients at risk of NCD onset.

The Role of Sleep and Sleep Disorders in the Development, Diagnosis, and Management of Neurocognitive Disorders.

It is becoming increasingly apparent that sleep plays an important role in the maintenance, disease prevention, repair, and restoration of both mind and body. The sleep and wake cycles are controlled by the pacemaker activity of the superchiasmic nucleus in the hypothalamus but can be disrupted by diseases of the nervous system causing disordered sleep. A lack of sleep has been associated with an increase in all-cause mortality. Likewise, sleep disturbances and sleep disorders may disrupt neuronal pathways and have an impact on neurological diseases. Sleep deprivation studies in normal subjects demonstrate that a lack of sleep can cause attention and working memory impairment. Moreover, untreated sleep disturbances and sleep disorders such as obstructive sleep apnoe (OSA) can also lead to cognitive impairment. Poor sleep and sleep disorders may present a significant risk factor for the development of dementia. In this review, the underlying mechanisms and the role of sleep and sleep disorders in the development of neurocognitive disorders [dementia and mild cognitive impairment (MCI)] and how the presence of sleep disorders could direct the process of diagnosis and management of neurocognitive disorders will be discussed.