Moderate Cognitive Dysfunction Research Articles

Efficacy of exercise rehabilitation for managing patients with Alzheimer's disease.

Alzheimer's disease (AD) is a progressive and degenerative neurological disease characterized by the deterioration of cognitive functions. While a definitive cure and optimal medication to impede disease progression are currently unavailable, a plethora of studies have highlighted the potential advantages of exercise rehabilitation for managing this condition. Those studies show that exercise rehabilitation can enhance cognitive function and improve the quality of life for individuals affected by AD. Therefore, exercise rehabilitation has been regarded as one of the most important strategies for managing patients with AD. Herein, we provide a comprehensive analysis of the currently available findings on exercise rehabilitation in patients with AD, with a focus on the exercise types which have shown efficacy when implemented alone or combined with other treatment methods, as well as the potential mechanisms underlying these positive effects. Specifically, we explain how exercise may improve the brain microenvironment and neuronal plasticity. In conclusion, exercise is a cost-effective intervention to enhance cognitive performance and improve quality of life in patients with mild to moderate cognitive dysfunction. Therefore, it can potentially become both a physical activity and a tailored intervention. This review may aid the development of more effective and individualized treatment strategies to address the challenges imposed by this debilitating disease, especially in low- and middle-income countries.

Cognitive enrichment and education quality moderate cognitive dysfunction in black and white adults with multiple sclerosis.

To examine the extent to which three sociobehavioral proxies of cognitive reserve-years of education, education quality, and cognitive enrichment-differ in their prediction of cognitive performance among Black and White people with MS (PwMS). 82 PwMS (Black n=41, White n=41) underwent a neurological examination and a neuropsychological evaluation that included tests of word recognition (Wechsler Test of Adult Reading) as well as measures of verbal memory, visuospatial memory, and processing speed (the Brief International Cognitive Assessment for MS; BICAMS). Participants rated their lifetime engagement in various cognitively-enriching activities (Cognitive Reserve Scale). For the full sample, education quality and cognitive enrichment were more strongly associated with cognitive performance than were years of education. Cognitive enrichment was not associated with cognitive performance among participants with high education quality. In contrast, among participants with low education quality, cognitive enrichment was strongly associated with cognitive performance, suggesting that high engagement in cognitively-enriching activities provided similar protection to high education quality. Furthermore, among Black participants, cognitive enrichment and educational quality moderated the relationship between disability level and cognitive performance. In contrast, among White participants, cognitive enrichment did not provide additional protection beyond the buffering effect of education quality. PwMS can successfully build reserve through multiple routes, including formal education or informal cognitive enrichment. Treatment for MS should incorporate cognitively-enriching activities to build resilience against cognitive decline, particularly for members of marginalized racial/ethnic groups, who are at greatest risk for poor health outcomes, and for whom years of education may not best reflect education quality.

Dementia Diagnosis and Alternate Treatment: A Recent Update on Treatment Options

Dementia is a global health burden identified by the World Health Organization in its global action plan on the public health response to dementia 2017-2025. Our study aims to determine the efficacy of treatment options in Alzheimer’s disease and related dementia (ADRD). The initiation of dementia treatment has consistently posed a significant dilemma for healthcare professionals, necessitating careful consideration when selecting the appropriate group of medications to commence therapy, considering the specific type of treatment required. To conduct our study, we searched PubMed Central and the Cochrane database to identify comparative trials that compared different dementia treatment options. Our objective was to evaluate the effectiveness of various treatment approaches across different types of dementia. In total, we reviewed over 40 papers that provided valuable insights into the comparative outcomes of these treatment options. In our analysis, we have found mild to moderate cognitive dysfunction (MMSE 19 to 26) and newly diagnosed Alzheimer's disease can be treated with a trial of Cholinesterase inhibitors (Donepezil, Galantamine, and Rivastigmine); choice can be based on clinician and/or patient preference, as efficacy is similar. Moderate to advanced dementia (MMSE 10 to 18): Memantine (10 mg twice daily) is a suggested option with Cholinesterase inhibitors. In conclusion, it is evident that the available options for dementia medication are inherently limited, while the resources allocated to evaluate further treatment alternatives remain constrained. As a result, there is an urgent need to prioritize additional research and comprehensive assessment in this field.

The use of antidementia therapy in non-dementia cognitive disorders associated with COVID-19

IntroductionThe new coronavirus infection causes severe damage to the human body. One of the most serious complication is cognitive impairment.According to a meta-analysis by Maxime Taquet et al. (2021), which assessed neurological and psychiatric outcomes among 236,379 patients diagnosed with COVID-19, 1.7% of participants over 65 years of age were diagnosed with dementia.In a US online survey of 1,500 people (Sarah Ballou et al., 2020), about half reported difficulty concentrating on any task after experiencing COVID-19.It was also found that there is a decrease in the speed of reactions and problem-solving (Jeffrey D. Pyne et al., 2021).There are a number of studies that present the evidence-based efficacy of acetylcholinesterase (AChE) inhibitors in dementia prevention.However, in accordance with clinical guidelines for cognitive disorders in the elderly, anti-dementia drugs are not used at the stage of mild to moderate cognitive impairment (Ministry of Health of the Russian Federation, 2020).ObjectivesThe use of AChE inhibitors in cognitive impairments that do not reach the degree of dementia.MethodsResearch data from open sources.ResultsThe development of early cholinergic deficiency correlates with the development of cognitive impairment, while acetylcholine has a pronounced neuroplastic effect and increases the number of neurons (Gabriela Dumitrita Stanciu et al., 2019).In a double-blind, placebo-controlled study, a positive effect of rivastigmine was found in patients with mild to moderate cognitive impairment. The study’s results show that rivastigmine treatment (3, 6, 9 mg/day) for six months increases brain activity of the hippocampus in the control group by 32,5%. Rivastigmine prevented the clinical progression of symptoms of cognitive impairment and caused activation of some parts of the cerebral cortex (Nagaendran Kandiah et al., 2017).In a study by Wolfson C. et al. (2002), it was found that rivastigmine can slow down the development of cognitive impairment for at least six months in patients with mild to moderate massive cognitive dysfunction. Subjects treated with 1 to 21 mg per day for 7 to 12 weeks got more favorable ADAS-cog scores for the six months after treatment. While those who took the drug in doses of 6 to 12 mg showed a more pronounced positive effect compared to the placebo group.The Luca Rozzini in 2006 conducted a study based on 59 subjects with mild cognitive impairment. 15 subjects received both neuropsychological examination and acetylcholinesterase inhibitors. As a result, the remaining subjects were behind in terms of abstract thinking and behavioral symptoms, in comparison with a combined treatment group.ConclusionsIt is advisable to conduct further studies on the effectiveness of AChE inhibitors to prevent the progression of mild to moderate cognitive impairment and their transition to dementia.Disclosure of InterestNone Declared

Evaluation of blood interleukin levels and their correlations in the patients with diabetic retinopathy with mild and moderate cognitive impairment

Systemic immunological disorders are associated with various geriatric conditions, including cognitive dysfunction. However, in patients with diabetic retinopathy, the changes of blood interleukin profile were studied without considering the severity of cognitive impairment. The aim of this study was to analyze blood plasma levels and intercorrelations of interleukins in the patients with diabetic retinopathy accompanied by mild and moderate cognitive impairment. Fifty-four elderly patients with diabetic retinopathy and mild cognitive impairment, and 62 patients with diabetic retinopathy and moderate cognitive disorders underwent inpatient examination and treatment at the Tambov branch of the S. Fedorov Center of Eye Microsurgery over 2021-2022. The interleukins contents in blood plasma were studied by enzyme immunoassay using the Protein Contour kit, including IL-1α, IL-1β, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12, IL-17, IL-18. The diagnostics of diabetic retinopathy was based on comprehensive ophthalmological examination, according to the Clinical recommendations of the Society of the Russian Association of Ophthalmologists «Diabetes mellitus: diabetic retinopathy, diabetic macular edema». Cognitive functions were assessed according to a valid Mini- Mental-State-Examination scale. It has been shown that the patients with diabetic retinopathy and moderate cognitive impairment have a significantly increased level of all the studied proinflammatory interleukins, as compared to similar cohort with diabetic retinopathy accompanied by a mild cognitive impairment. In mild cognitive disorders, the content of IL-6 in blood plasma was higher (24.4±2.1 pg/mL versus 5.1±0.8 pg/mL, p < 0.001). Development of moderate cognitive impairment in the patients with diabetic retinopathy was also accompanied by a statistically significant increase of plasma IL-8 to 36.7±3.5 pg/mL versus 10.5±2.3 pg/mL with mild cognitive impairment; IL-17, to 21.9±1.8 pg/mL versus 8.5±1.1 pg/mL, respectively. Concentrations of anti-inflammatory interleukins in blood plasma of the patients with diabetic retinopathy and moderate cognitive dysfunction were significantly decreased, i.e., IL-4 to 2.1±0.3 pg/mL versus 3.4±0.5 pg/mL in cases of mild mental deterioration; IL-10, to 8.7±0.5 pg/mL versus 15.4±1.3 pg/mL, respectively. A sufficient correlation was shown between the levels of systemic interleukins and moderate cognitive disorders in the patients with diabetic retinopathy. For the proinflammatory interleukins in cases of moderate cognitive impairment, an inverse correlations with IL-1β (r = -0.336; p = 0.021), IL-6 (r = -0.584; p = 0.019), IL-8 (r = -0.469; p = 0.006), and with IL-17 (r = -0.348; p = 0.018) were shown. The content of IL-4 and IL-10 in blood plasma of the patients with diabetic retinopathy correlated with moderate cognitive impairment at a significant level of r = +0,407 (p = 0.016) and r = +0.359 (p = 0.008), respectively. In mild cognitive impairment, the correlations with fewer numbers of interleukins were revealed, i.e., IL-1β, IL-6, IL-8 and IL-10, and exhibit weaker connections, except of IL-6 (a moderate connection level). Development of moderate cognitive impairment among the patients with diabetic retinopathy may be caused by increase in IL-1β, IL-6, IL-8, IL-17, and a decrease in IL-10.

Cognitive and behavioral changes in amyotrophic lateral sclerosis

BACKGROUND. Amyotrophic lateral sclerosis (ALS) is not limited only to motor impairment, and can also manifest with cognitive and behavioral disorders. Currently these presentations of ALS are unrecognized. Hence the research of ALS variants with cognitive and behavioral impairments is necessary.
 AIM. To study the frequency and clinical characteristics of ALS variants with cognitive and behavioral impairments.
 MATERIAL AND METHODS. The patients were recruited in 20202021. All patients with definite and possible ALS according to El Escorial criteria were included. The Edinburgh Cognitive and Behavioral ALS Screen (ECAS) was used to assess cognitive and behavioral changes. 44 patients, 26 males and 18 females, aged 39 to 77 years (median of age 61 years, interquartile range 53.574.5). Statistical analysis was performed using IBM SPSS Statistics 21. Continuous data were analyzed using the MannWhitney test, categorical data was analyzed by exact Fisher criteria. A p-value less than 0.05 was statistically significant.
 RESULTS. In 43.2% of patients cognitive and/or behavioral changes were observed. The majority of patients (approximately 20%) suffered from a variant of ALS with cognitive impairment, which was mostly presented with executive and social cognitive dysfunction. ALS with behavioral impairment was observed at 9% of patients, which mostly presented with apathy and disinhibition. A combination of cognitive and behavioral impairment was registered in 7% of patients. In another 7% of patients severity of cognitive and behavioral impairment reached a degree of dementia and corresponded to frontotemporal degeneration.
 CONCLUSION. This cognitive and behavioral impairment is observed in a substantial number of patients with ALS and mostly presented with moderate executive and social cognitive dysfunction, as well as apathy and less often disinhibition.

Predictors of cognitive dysfunction in hereditary transthyretin amyloidosis with liver transplant

Background Cognitive dysfunction is part of the broad spectrum of clinical manifestations in older untreated hereditary transthyretin amyloidosis patients with peripheral polyneuropathy. Objective The objective of this study is to systematically explore cognitive dysfunction in ATTRV30M amyloidosis patients whose disease course was modified by liver transplant (LT). Methods A series of 269 carriers of TTRVal30Met mutation treated with LT underwent a neuropsychological assessment. Clinical charts were reviewed to identify focal neurological episodes (FNEs), cognitive complaints and laboratory results. Chi-square and Mann–Whitney tests explored potential predictors of cognitive dysfunction. Results Cognitive dysfunction was identified in 35 patients (13%)−14 (5%) had mild and 21 (8%) had moderate dysfunction. In comparison to normal cognition, both mild and moderate cognitive dysfunction patients had older age, higher mPND score and elevated NT-proBNP and Cystatin C values. Mild cognitive dysfunction was associated with longer disease duration and history of FNEs, whereas moderate dysfunction was related to older age at disease onset and more cognitive complaints and depression symptoms. Conclusions Consistent with the natural history of the disease, older age and higher severity of the disease are significantly associated and potentially predictors of cognitive dysfunction in ATTRV30M patients treated with LT. The level of cognitive dysfunction may depend on some clinical variables.

Prevalence and severity of cognitive dysfunction in patients referred for transcatheter aortic valve implantation (TAVI): clinical and cognitive impact at 1year.

We estimated the proportion and severity of cognitive disorders in an unselected population of patients referred for transcatheter aortic valve implantation (TAVI). Second, we describe clinical and cognitive outcomes at 1year. Eligible patients were aged ≥ 70years, with symptomatic aortic stenosis and an indication for TAVI. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive dysfunction (CD), defined as no CD if score ≥ 26, mild CD if 18-25; moderate CD if 10-18, and severe CD if < 10. We assessed survival and in-hospital complications at 6months and 1year. Between June 2019 and October 2020, 105 patients were included; 21 (20%) did not undergo TAVI, and thus, 84 were analyzed; median age 85years, 53.6% females, median EuroScore 11.5%. Median MoCA score was 22 (19-25); CD was excluded in 18 (21%), mild in 50 (59.5%), moderate in 15 (19%) and severe in 1. Mean MoCA score at follow-up was 21.9(± 4.69) and did not differ significantly from baseline (21.79 (± 4.61), p = 0.73). There was no difference in success rate, in-hospital complications, or death across CD categories. The clinical course of patients with mild or moderate CD is not different at 1year after TAVI compared to those without cognitive dysfunction.

Management of Psychiatric Disorders in Patients with Respiratory Diseases.

Management of Psychiatric Disorders in Patients with Respiratory Diseases.

Validation of the Saint Louis University Quality of Life Questionnaire in Older Adults with Alzheimer's Disease.

Alzheimer's disease (AD) is the most common cause of dementia and negatively impacts individuals' quality of life (QOL). One essential component of disease management in older adults with AD is the maintenance and improvement of QOL. The QOL-AD is a tool that can be administered to evaluate QOL in AD patients, but it can take too long to administer in a patient visit. The purpose of this study was to investigate the validity of a more brief, 6-item QOL questionnaire, LIFEAD, comparing it to the QOL-AD in older adults with mild to moderate cognitive dysfunction. Prospective validation study. Participants were patients presenting to internal medicine and geriatrics outpatient clinics and a nursing home. 285 adults 65 and older with mild to moderate cognitive impairment. QOL was assessed using LIFEAD and the QOL-AD. Demographic data were collected and level of depression was determined through a demographic questionnaire and the PHQ-8, respectively. QOL-AD mean item scores ranged from 2.27-3.32 with an average scale total of 36.28 ± 6.48. LIFEAD mean item scores ranged from 2.26-2.51 with an average scale total of 14.28 ± 2.87. A majority (68%) of patients rated all items on LIFEAD as either average or good. The correlation between LIFEAD and the QOL-AD was 0.71 (p<0.001). Both LIFEAD and the QOL-AD showed strong internal consistency with a Cronbach's alpha of 0.82 and 0.87, respectively. This study validated LIFEAD and exhibited LIFEAD can assess QOL in older adults with mild to moderate cognitive dysfunction in the clinic or nursing home. LIFEAD is a short, practical questionnaire and is easily administered in approximately 1 minute. Further research on LIFEAD could be done with larger samples, in different clinical populations, and including persons of other ethnic backgrounds.

Assessment of cognitive dysfunction using the Montreal Cognitive Assessment test: rate, severity and comparison with the Clock test alone in a population of patients referred for TAVI

Abstract Background Although not recommended in routine practice, the detection and quantification of Cognitive Dysfunction (CD) in older patients might have an impact on clinical decisions. We assessed the rate and severity of CD in an unselected population of patients referred for Transcatheter Aortic Valve Implantation (TAVI) using the Montreal Cognitive Assessment (MoCA) and using the Clock Drawing Test (ClockT) alone. Methods The MoCA was performed before TAVI by an experienced operator. The ClockT was scored out of 10 points according to the Rouleau rating scale. CD was defined according to the MoCA score: No CD if score ≥26, mild CD if score 18–25, moderate if 10–17 and severe if &amp;lt;10. Inter-observer reliability of scoring on the ClockT was estimated with the Bland-Altman method. Agreement between MoCA scores and the ClockT for ruling out and for detecting CD were measured with the Kappa coefficient. Results MoCA was performed in 83 consecutive patients referred for TAVI, median age 85 years. The mean time required for assessment was 11±2 min for the MoCA and 3±2 min for the ClockT. The mean MoCA score was 21±4.5: CD was excluded in 17 (20%) pts, mild CD was found in 50 (60%), moderate in 15 (18%) and severe in one (1%). The median ClockT score was 8 (interquartile 6; 9), with excellent inter-observer concordance (Kappa= 0.84). Overall, 51% of the variance of the MoCA score was explained by the ClockT alone according to multiple regression. A ClockT &amp;lt;7 detected a group with significantly lower MoCA score, compared to pts with higher ClockT scores (figure). Conclusion Among patients referred for TAVI, CD can be excluded using the MoCA test in 20%, while moderate or severe CD is observed in 18%. The ClockT alone is faster to implement, reliable to interpret and enabled detection of patients with moderate CD when Rouleau scoring was &amp;lt;7. Funding Acknowledgement Type of funding sources: None.

Abstract 11023: Assessment of Cognitive Dysfunction Using the Montreal Cognitive Assessment Test: Rate, Severity and Comparison with the Clock Test Alone in a Population of Patients Referred for TAVI

Introduction: Although not recommended in routine practice, the detection and quantification of Cognitive Dysfunction (CD) in older patients might have an impact on clinical decisions. Hypothesis: We assessed the rate and severity of CD in an unselected population of patients referred for Transcatheter Aortic Valve Implantation (TAVI) using the Montreal Cognitive Assessment (MoCA) and using the Clock Drawing Test (ClockT) alone. Methods: The MoCA was performed before TAVI by an experienced operator. The ClockT was scored out of 10 points according to the Rouleau rating scale. CD was defined according to the MoCA score: No CD if score ≥26, mild CD if score 18-25, moderate if 10-17 and severe if &lt;10. Inter-observer reliability of scoring on the ClockT was estimated with the Bland-Altman method. Agreement between MoCA scores and the ClockT for ruling out and for detecting CD were measured with the Kappa coefficient. Results: MoCA was performed in 83 consecutive patients referred for TAVI, median age 85 years. The mean time required for assessment was 11±2 min for the MoCA and 3±2 min for the ClockT. The mean MoCA score was 21± 4.5: CD was excluded in 17(20%) pts, mild CD was found in 50(60%), moderate in 15(18%) and severe in one (1%). The median ClockT score was 8 (interquartile 6; 9), with excellent inter-observer concordance (Kappa= 0.84). Overall, 51% of the variance of the MoCA score was explained by the ClockT alone according to multiple regression. A ClockT &lt;7 detected a group with significantly lower MoCA score, compared to pts with higher ClockT scores (figure). Conclusions: Among patients referred for TAVI, CD can be excluded using the MoCA test in 20%, while moderate or severe CD is observed in 18%. The ClockT alone is faster to implement, reliable to interpret and enabled detection of patients with moderate CD when Rouleau scoring was &lt;7.

Abstract 11012: Cognitive Dysfunction Among Patients Referred for Transcatheter Aortic Valve Implantation: Results of the Montreal Cognitive Assessment and Clinical Impact at 6 Months

Introduction: Detection of Cognitive Dysfunction (CD) is not routinely performed among patients undergoing Transcatheter Aortic Valve Implantation (TAVI). Hypothesis: We sought to determine whether CD has an impact on the clinical course of these patients, during hospitalization at the time of TAVI and up to 6 months afterwards. Methods: The MoCA was performed before TAVI by an experienced operator in an unselected population of patients referred for TAVI. CD was defined according to the MoCA score: No CD if score ≥26, mild CD if score 18-25, moderate if 10-17 and severe if &lt;10. Multivariate Cox logistic regression analysis was used to determine the impact of CD on procedural success of TAVI, length of stay, 6 month survival, re-admission, and change in clinical status (changes in NYHA class and/or functional status). Results: MoCA was performed in 83 consecutive patients. TAVI was performed using femoral access and local anesthesia in all patients. There were no procedural deaths, and 2 deaths at 6 months. The median age was 85 years, and median Euroscore I was 11.62. The median MOCA score was 22, CD was excluded in 17(20%), mild in 50 (60%), moderate in 15 (18%) and severe in one patient. No difference was observed in rate of procedural success, 6 month mortality, re-admission, degree of dyspnea by NYHA between the different cognitive groups. Length of stay after the TAVI procedure was lower in patients without CD, compared to those with CD at any level: 3±1 days versus 4.3±1 days, p=0.045, and p=0.02 by multivariate analysis (figure). Conclusions: Among patients referred for TAVI, mild or moderate CD was observed in 80% of patients. Patients without CD had a shorter length of stay at the time of TAVI, but CD was not associated with worse prognosis or clinical status at 6 months.

Assessment of cognitive dysfunction using the Montreal Cognitive Assessment test: rate, severity and comparison with the Clock test alone in a population of patients referred for TAVI

Abstract Background Although not recommended in routine practice, the detection and quantification of Cognitive Dysfunction (CD) in older patients might have an impact on clinical decisions. We assessed the rate and severity of CD in an unselected population of patients referred for Transcatheter Aortic Valve Implantation (TAVI) using the Montreal Cognitive Assessment (MoCA) and using the Clock Drawing Test (ClockT) alone. Methods The MoCA was performed before TAVI by an experienced operator. The ClockT was scored out of 10 points according to the Rouleau rating scale. CD was defined according to the MoCA score: No CD if score ≥26, mild CD if score 18–25, moderate if 10–17 and severe if &amp;lt;10. Inter-observer reliability of scoring on the ClockT was estimated with the Bland-Altman method. Agreement between MoCA scores and the ClockT for ruling out and for detecting CD were measured with the Kappa coefficient. Results MoCA was performed in 83 consecutive patients referred for TAVI, median age 85 years. The mean time required for assessment was 11±2 min for the MoCA and 3±2 min for the ClockT. The mean MoCA score was 21±4.5: CD was excluded in 17 (20%) pts, mild CD was found in 50 (60%), moderate in 15 (18%) and severe in one (1%). The median ClockT score was 8 (interquartile 6; 9), with excellent inter-observer concordance (Kappa= 0.84). Overall, 51% of the variance of the MoCA score was explained by the ClockT alone according to multiple regression. A ClockT &amp;lt;7 detected a group with significantly lower MoCA score, compared to pts with higher ClockT scores (figure). Conclusion Among patients referred for TAVI, CD can be excluded using the MoCA test in 20%, while moderate or severe CD is observed in 18%. The ClockT alone is faster to implement, reliable to interpret and enabled detection of patients with moderate CD when Rouleau scoring was &amp;lt;7. Funding Acknowledgement Type of funding sources: None.

Cognitive dysfunction among patients referred for transcatheter aortic valve implantation: results of the Montreal Cognitive Assessment and clinical impact at 6 months

Abstract Background Detection of Cognitive Dysfunction (CD) is not routinely performed among patients undergoing Transcatheter Aortic Valve Implantation (TAVI). We sought to determine whether CD has an impact on the clinical course of these patients, during hospitalization at the time of TAVI and up to 6 months afterwards. Methods The MoCA was performed before TAVI by an experienced operator in an unselected population of patients referred for TAVI. CD was defined according to the MoCA score: No CD if score ≥26, mild CD if score 18–25, moderate if 10–17 and severe if &amp;lt;10. Multivariate Cox logistic regression analysis was used to determine the impact of CD on procedural success of TAVI, length of stay, 6 month survival, re-admission, and change in clinical status (changes in NYHA class and/or functional status). Results MoCA was performed in 83 consecutive patients. TAVI was performed using femoral access and local anesthesia in all patients. There were no procedural deaths, and 2 deaths at 6 months. The median age was 85 years, and median Euroscore I was 11.62. The median MOCA score was 22, CD was excluded in 17 (20%), mild in 50 (60%), moderate in 15 (18%) and severe in one patient. No difference was observed in rate of procedural success, 6 month mortality, re-admission, degree of dyspnea by NYHA between the different cognitive groups. Length of stay after the TAVI procedure was lower in patients without CD, compared to those with CD at any level: 3±1 days versus 4.3±1 days, p=0.045, and p=0.02 by multivariate analysis (figure). Conclusion Among patients referred for TAVI, mild or moderate CD was observed in 80% of patients. Patients without CD had a shorter length of stay at the time of TAVI, but CD was not associated with worse prognosis or clinical status at 6 months. Funding Acknowledgement Type of funding sources: None.

THE RELATION OF LONG-SUFFERING FOR HYPERTENSION AND FRAILTY WITH COGNITIVE FUNCTION STATUS IN ELDERLY AT PSTW BUDI MULIA 2 CENGKARENG

The increase in the elderly population in the world has resulted in an epidemiological transition in the health sector so that there can an increase in the number of morbidity due to degenerative diseases, namely cognitive function problems. Poor cognitive function status can influenced by one of the respondent's characteristic domains such as the length of history of hypertension and the domain of health risk factors such as frailty. This study aims to find the relationship between long-suffering from hypertension and frailty on cognitive function status in elderly patients at PSTW Budi Mulia 2 Cengkareng. The research design used is descriptive analytic with a cross-sectional approach. Collecting data using the questionnaire The Edmonton Frailty Scale (EFS) and the Short Portable Mental Status Questionnaire (SPMSQ) which have been test for validity and reliability. The sample consisted of 58 respondents who were take using purposive sampling technique. Data analysis used in this study is the Pearson correlation. This study shows that 81% of respondents are between 60-74 years old, female gender is 67.2%, primary school education level is 56.9%. Meanwhile, the length of the elderly suffering from hypertension ≤5 years was 65.5%, mild frailty was 67.2%, and moderate cognitive dysfunction was 36.2%. The results of the Pearson correlation statistical test showed that there was a relationship between the length of suffering from hypertension and the cognitive function status with a value of p = 0.004 and there was a relationship between frailty and the cognitive function status with a value of p = 0.001. Elderly advised to support health by controlling a low salt diet so that cognitive decline does not become chronic so that they do not develop dementia and control frailty by eating foods high in energy and protein so that they do not worsen cognitive function.&#x0D; Keywords: Frailty; Length of Suffering from Hypertension; Status of Cognitive Function&#x0D;

The relationship between blood pressure and cognitive function

BackgroundAlthough an elevated systolic blood pressure (SBP) is associated with cognitive dysfunction, BP may decrease with advanced cognitive dysfunction; therefore, we attempted to identify the turning point in the relationship between cognitive function and SBP in elderly subjects. MethodsIn pooled datasets of general populations and outpatient clinics (age>65 years), in which the risk of frailty or cognitive dysfunction was assessed (N = 4076), the relationship between SBP and the Mini Mental State Examination (MMSE) score was examined. ResultsMean age was 72.5 ± 6.2 years (male 45.1%), and SBP was 133.0 ± 19.5 mmHg. In an analysis of locally weighted scatter plot smoothing, the relationship between SBP and MMSE scores changed at an MMSE score of 24 points. In subjects with preserved cognitive function (MMSE ≥24 points), MMSE scores decreased with increases in SBP (B = −0.047 per 10 mmHg increase, P = 0.002) after adjustments for age, sex, body mass index, alcohol habit, smoking status, diabetes, a history of stroke, and the geriatric nutritional index; however, in subjects with reduced cognitive function (MMSE<24 points), decreases in the MMSE score were associated with reductions in SBP (B = 1.178 per 1 point decrease in the MMSE score, P = 0.002). ConclusionThe relationship between SBP and cognitive function changed at a MMSE score of approximately 24 points (mild to moderate cognitive dysfunction). In patients with preserved MMSE, higher BP values were associated with a reduction of cognitive function, but this was not a case for those with impaired MMSE.

Clinical Study of Endovascular Treatment of Severe Middle Cerebral Artery Stenosis or Occlusion and Vascular Cognitive Impairment

Objective: It is very important to study the factors affecting the incidence, progress and prognosis of patients with vascular dementia. Methods: 50 cases of severe middle cerebral artery stenosis or occlusion underwent endovascular treatment (25 cases of mild cognitive dysfunction, 25 cases of moderate cognitive dysfunction) were divided into two groups, where a medical drug treatment group and a control group established with 25 cases in each group. The cognitive function of each group of patients was evaluated before operation, 7 days after operation, 30 days after operation, and 180 days after operation. CTP was used to compare the hemodynamic changes in patients before and after operation. Results: The severe stenosis or occlusion of the middle cerebral artery in patients can be improved, and the intracranial blood supply of patients with poorly compensated medial cranial circulation and hypoperfusion can be restored to a certain extent. Meanwhile, improvement of cognitive function was definitive in some patients with cognitive dysfunction. Conclusion: To guide the formulation of treatment plans for patients with severe middle cerebral artery stenosis or occlusion.

Biomarkers of vascular cognitive impairment

There is currently no approved list of vascular cognitive impairment biomarkers. The main problem for the practitioner in identifying cognitive impairment in patients is the differential diagnosis of Alzheimer's disease, vascular cognitive impairment, and other diseases, which are much less common. Vascular cognitive impairment includes post-stroke dementia, cognitive dysfunction in cardio-and cerebrovascular diseases. Without etiology identification, it is impossible to prescribe adequate treatment. Another challenge is identifying cognitive impairment before dementia develops. This literature review is devoted to the search and critical analysis of candidates for biomarkers of vascular cognitive impairment and the establishment of markers of moderate cognitive dysfunction. The papers were searched for in the Web of Science and PubMed databases. A list of cerebrospinal fluid, plasma, serum and genetic biomarkers was made, allowing for differential diagnosis between vascular impairment and Alzheimer's disease. The markers of moderate cognitive dysfunction, which make it possible to identify cognitive impairment at the pre-dementia stage, were also identified.

Cognitive heterogeneity in the offspring of patients with schizophrenia or bipolar disorder: a cluster analysis across family risk

BackgroundNeurocognitive impairment is considered to lie on a continuum of severity across schizophrenia (SZ) and bipolar disorder (BP), possibly reflecting a gradient of neurodevelopmental load. Cluster analyses have identified different levels of impairment across the two disorders, from none to widespread and severe. We for the first time used this approach to examine cognitive function pooling together children and adolescents at familial risk of SZ or BP. Methods220 participants, 49 offspring of individuals with schizophrenia (SZO), 90 offspring of individuals with bipolar disorder (BPO) and 81 offspring of healthy control parents (HC), aged 6 to 17 years, underwent a comprehensive clinical and cognitive assessment. Cognitive measures were used to group SZO and BPO using K-means clustering. Cognitive performance within each of the clusters was compared to that of HC and clinical variables were compared between clusters. ResultsWe identified three cognitive subgroups: a moderate impairment group, a mild impairment group, and a cognitively intact group. Both SZO and BPO were represented in each of the clusters, yet not evenly, with a larger proportion of the SZO in the moderately impaired cluster, but also a subgroup of BPO showing moderate cognitive dysfunction. LimitationsParticipants have yet to reach the age of onset for the examined disorders. ConclusionsThe findings point to a range of neurodevelopmental loadings across youth at familial risk of both SZ and BP. They have therefore important implications for the stratification of cognitive functioning and the possibility to tailor interventions to individual levels of impairment.