Neuropsychiatric Status Research Articles

Gut Microbiota Alterations in Alzheimer's Disease: Relation with Cognitive Impairment and Mediterranean Lifestyle.

Recently, an association between dysbiosis of the gut microbiota (GMB) and the development of several diseases, such as Alzheimer's disease (AD), has been proposed. Dysbiosis involves changes in microbial diversity influenced by environmental factors, like diet or lifestyle. In this study, we investigated the role of GMB parameters in Spanish AD patients, assessing the impact of adherence to the Mediterranean lifestyle (ML), as well as to characterize these parameters in relation to neuropsychological, neuropsychiatric, emotional, and functionality parameters. A case-control study was conducted to investigate the association between the composition of the GMB and cognitive, emotional, neuropsychiatric, and functionality status in Spanish AD patients, along with a shotgun metagenomics approach. Richness and alpha-diversity were significantly lower in the AD group compared to the controls. PERMANOVA and ANOSIM tests of Bray-Curtis dissimilarity, Aitchison distance, and Jaccard similarity did not showed significant differences in beta-diversity between the two groups. Moreover, associations between various phyla of the AD group and orientation performance, food consumption, and activities of daily living were identified. Dysbiosis observed in Spanish AD patients is characterized by reductions in richness and alpha-diversity, alongside alterations in GMB composition, which may be linked to adherence to the ML and cognitive and functionality symptoms.

Temporal bisection task as a predictor of cognitive deficits.

Evidence suggests that neuropsychiatric symptoms and deficits in attentional control and executive function can impair time discrimination, demonstrating the intricate link between cognitive processes, subjective well-being, and perception of time. However, the relationship between sleep quality and time discrimination remains elusive. This study aimed to understand differences in the temporal bisection task (TBT) performance. We expected that individuals with impaired cognition, executive function, quality of life, or sleep quality would have reduced time sensitivity. At the same time, those with stress, anxiety, or depression would show a shift in the point of subjective equality. Data were collected from 97 female participants (ranging from 20 to 72 years of age) in more than one moment, resulting in 163 measurements used for the analysis. Participants' neuropsychiatric status was assessed using a battery of tests and scales, including the Mini-Mental State Examination (MMSE), the Frontal Assessment Battery (FAB), the World Health Organization Quality of Life Questionnaire (WHOQOL), the Pittsburgh Sleep Quality Index (PSQI), and the Depression, Anxiety, and Stress Scale-21 items (DASS-21). The results showed that attention and executive control significantly affect time discrimination. In addition, the research indicated that better sleep quality is associated with improved time discrimination sensitivity.

Hyperekplexia: A Single-Center Experience.

Hyperekplexia is a rare neurogenetic disorder that is classically characterized by an exaggerated startle response to sudden unexpected stimuli. This study aimed to determine clinical and genetic characteristics of our patients with hyperekplexia. The age of onset and diagnosis, familial and perinatal history, clinical course, complications, metabolic screening tests, magnetic resonance imaging (MRI), medications, neuropsychometric evaluations, and gene mutations of patients diagnosed with hyperekplexia were reviewed retrospectively. All hyperekplexia patients had displayed neonatal excessive startle response and muscle stiffness, which we accepted as the major form of the disorder. Sixteen patients had mutations in genes associated with hyperekplexia. The ages at clinical diagnosis and genetic confirmation ranged from newborn to 16 years old and from 2.5 to 19 years, respectively. Nine patients (56.25%) were initially misdiagnosed with epilepsy. Seven patients (43.75%) carried a diagnosis of intellectual disability, defined here as a total IQ <80. Delayed gross motor development was detected in 4 patients (25%), and speech delay was reported in 3 (18.75%). Mutations in GLRA1 (NM_000171.4) and SLC6A5 (NM_004211.5) were identified in 13 (81.25%) and 3 patients (18.75%), respectively. Fifteen of the 16 patients (93.75%) showed autosomal recessive inheritance. Only 1 patient (6.25%) showed autosomal dominant inheritance. Although hyperekplexia is a potentially treatable disease, it can be complicated by delayed speech and/or motor acquisition and also by intellectual disability. This study shows that hyperekplexia is not always a benign condition and that all patients diagnosed with hyperekplexia should be evaluated for neuropsychiatric status and provided with genetic testing.

Generating real-world evidence in Alzheimer's disease: Considerations for establishing a core dataset.

Ongoing assessment of patients with Alzheimer's disease (AD) in postapproval studies is important for mapping disease progression and evaluating real-world treatment effectiveness and safety. However, interpreting outcomes in the real world is challenging owing to variation in data collected across centers and specialties and greater heterogeneity of patients compared with trial participants. Here, we share considerations for observational postapproval studies designed to collect harmonized longitudinal data from individuals with mild cognitive impairment or mild dementia stage of disease who receive therapies targeting the underlying pathological processes of AD in routine practice. This paper considers key study design parameters, including proposed aims and objectives, study populations, approaches to data collection, and measures of cognition, functional abilities, neuropsychiatric status, quality of life, health economics, safety, and drug utilization. Postapproval studies that capture these considerations will be important to provide standardized data on AD treatment effectiveness and safety in real-world settings.

Thrombotic and neuropsychiatric sequelae in post-coronavirus disease 2019 end-stage renal disease patients on maintenance hemodialysis

Background End-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD) are highly vulnerable to severe manifestations of coronavirus disease 2019 (COVID-19) as increased risk of thromboembolic disease and worsened neuropsychiatric status. Aim To assess the long-term thrombotic and neuropsychiatric sequelae of severe acute respiratory syndrome corona virus 2 in post-COVID-19 ESRD patients on MHD. Patients and methods We followed for 12 months, 35 clinically stable HD patients on MHD who were confirmed or highly suspected for COVID-19 by positive severe acute respiratory syndrome corona virus 2 RT-PCR and/or high probability on high-resolution computed tomography chest imaging. We recorded demographics, HD and COVID-19 related data, thromboembolic history, and psychiatric history. We recorded baseline and follow-up complete blood count with differential counts, D-dimer, prothrombin time, international normalized ratio, and high-resolution computed tomography chest findings. We assessed post-COVID-19 neuropsychiatric sequelae using the Arabic versions of Hamilton’s depression rating scale and Taylor’s manifest anxiety scale. Results Total leukocytic count, lymphocytes, and platelets were significantly lower during infection than preinfection, 6 months, and 1-year postinfection (P&lt;0.001, P=0.003, P=0.014, respectively). Six months after infection, d-dimer levels were higher than normal values. The incidence of vascular access thrombosis was 25.7%. The scores of Hamilton’s depression rating scale and Taylor’s manifest anxiety scale were high [25 (interquartile range; 17–28) and 26 (interquartile range; 19–33)], respectively, and the prevalence of depression and anxiety symptoms were 94.3 and 85.7%, respectively. Conclusions During infection, ESRD patients showed significantly lower total leukocytic count, lymphocytes, and platelets than preinfection, 6 months, and 1-year postinfection. They had high levels of d-dimer 6 months postinfection and a high risk for vascular access thrombosis. Their psychological wellbeing was markedly impaired by the pandemic resulting in depression and anxiety.

К вопросу о тиреоидной функции щитовидной железы беременных, проживающих в йододефицитном районе (Республика Дагестан, Ахтынский район, 1675 м над уровнем моря)

The work shows that currently diseases associated with iodine deficiency in the diet are one of the most common non-communicable human diseases. Iodine deficiency contributes to a decrease in the synthesis and secretion of thyroid hormones, during pregnancy leads to the formation of the neuropsychiatric status of the fetus. Thyroid pathology is more common in women than in men. During pregnancy, thyroid pathology increases dramatically – pregnancy itself is a provoking factor. One of the important reasons is the deterioration of the environmental and radiation situation, the changing nature of the population's diet. The impact of the ecosystem on the health of the population can be determined based on data on the incidence of thyroid diseases in women of reproductive age in rural areas with iodine deficiency. The article presents data on the examination and treatment of 120 pregnant women (First Trimester of pregnancy) aged 20–40 years who are registered in the women's clinic of the Akhtyn regional hospital.

Micronized/ultramicronized palmitoylethanolamide improves depression and fatigue in coronavirus disease 2019 (COVID-19) survivors.

Coronavirus disease 2019 (COVID-19) may lead to neuropsychiatric sequelae. Palmitoylethanolamide (PEA) is an anti-inflammatory and neuroprotective amide used in depressive syndromes. Here we investigate whether micronized/ultramicronized (m/um) PEA improves neuropsychiatric sequelae in COVID-19 survivors. Patients evaluated at our post-COVID-19 outpatient clinic between February and August 2021 and presenting neuropsychiatric manifestations (n = 98) were offered treatment with m/umPEA 600 mg twice daily for 3 months. Those accepting m/umPEA therapy (n = 57) were compared with those who did not (n = 41), in terms of depression, fatigue, chronic pain and subjective well-being, through validated scales administered pre- and posttreatment. The two groups did not differ in terms of demographics, comorbidities, psychiatric history, antidepressant therapy, acute COVID-19 severity and baseline neuropsychiatric status. Patients receiving m/umPEA showed a greater improvement in depression and fatigue (both P < 0.05). Conversely, no association was found with changes in chronic pain or subjective well-being. At multivariable logistic regression, m/umPEA predicted neuropsychiatric improvement independently of age, sex and baseline neuropsychiatric status. Worse pretreatment fatigue and subjective well-being identified those who most likely benefited from treatment. In conclusion, despite its retrospective nature, our study suggests that m/umPEA may improve depression and fatigue in COVID-19 survivors, justifying future research in this setting.

Experience of using the combined drug Mioreol in patients with Alzheimer's disease and mixed dementia

The aim of the study was to evaluate the clinical efficacy, safety, and tolerability of a fixed-dose combination of donepezil and memantine (Mioreol) in patients with Alzheimer's disease (AD) and AD with cerebrovascular pathology. 497 patients with moderate to severe dementia, average age 75.4+6.81 years, received Mioreol (donepezil 10 mg+memantine 20 mg). Treatment efficacy was assessed using the MMSE, clock drawing, Sandoz Clinical Geriatric Scale, and Clinical Global Impressions after 3 months of therapy. All adverse events during treatment were recorded. The transition to Mioreol was accompanied by a reliable improvement in cognitive functions, emotional-behavioral indicators and neuropsychiatric status in general. Mioreol demonstrated clinical efficacy, safety and good tolerability in patients with AD and AD with cerebrovascular pathology with moderate to severe dementia syndrome.

МЕЖДИСЦИПЛИНАРНЫЙ ПОДХОД К ДИАГНОСТИКЕ И ЛЕЧЕНИЮ ПАЦИЕНТОВ С ДИСФУНКЦИОНАЛЬНЫМ СОСТОЯНИЕМ ВИСОЧНО-НИЖНЕЧЕЛЮСТНОГО СУСТАВА

The article is devoted to improving the effectiveness of diagnosis and treatment of a dysfunctional state of the TMJ from the standpoint of an interdisciplinary approach. The nature and prevalence of dental disorders, postural imbalance, and neuropsychiatric changes were determined. The algorithm of diagnosis and treatment of this group of patients is described.&#x0D; Purpose: to improve algorithms for the diagnosis and treatment of patients with a dysfunctional TMJ condition.&#x0D; Materials and methods. 136 patients with a dysfunctional state of the TMJ were examined, including 25 men (18.38%), 111 women (81.62%), aged 18 to 81 years. The median age was 43.17 years. Dental examination, registration of neuropsychiatric status and postural status of patients were carried out on the basis of diagnostic algorithms developed by us.&#x0D; Results. The examination revealed a high need for dental treatment of dentists of different profiles in patients with a dysfunctional state of the TMJ. The analysis of the postural status revealed deformities of the trunk in the neck, shoulder blades and pelvis, which led to moderate (59.18%) and severe violations (24.19%) of the postura. In this group of patients, the quality of life decreases, the mental (60%) and physical components of health are at an average level (80%), there is high personal anxiety (80%), with an average (60%) and high (40%) level of situational anxiety.&#x0D; Conclusions. The multifactorial and multi-morbidity of dysfunctional TMJ conditions requires an interdisciplinary approach to the diagnosis and treatment of patients suffering from this pathology. Dental treatment of patients should be carried out with the correction of neuropsychiatric status and postural status, which significantly increases the effectiveness of therapy and allows achieving more stable results.

Secondary Streptococcus pneumoniae infection increases morbidity and mortality during murine cryptococcosis.

Microorganisms that cause pneumonia and translocate to the central nervous system (CNS) are responsible for high mortality worldwide. The fungus Cryptococcus gattii (Cg) and the bacteria Streptococcus pneumoniae (Sp) target the same infection organs. This study aimed to investigate the consequences of secondary Sp infection during murine cryptococcosis. Mice infected with Sp after Cg showed significantly increased lethality and a drop in scores of motor behaviour, neuropsychiatric status and autonomous function. Previous Cg infection favoured Sp multiplication in the lungs, causing intense inflammation and necrosis, with further increased bacterial translocation to the spleen, liver and brain. This phenotype was associated with increased platelet-activating factor receptor (Pafr) gene expression, reduced M1 macrophage recruitment, and high levels of proinflammatory mediators. Strategies to overcome early mortality (i.e., infection of Pafr-/- mice, treatment with IL-1 inhibitor or corticoid) were insufficient to revert this phenotype. These results suggest that Cg infection makes the lung microenvironment favourable for Sp colonization and dissemination. Altogether, it leads to an exacerbated and ineffective inflammatory response, decisive for the increased morbidity and mortality during coinfection. In conclusion, our results highlight the importance of more studies addressing coinfections and their consequences in the host, aiming to establish more effective therapeutical strategies.

A - 127 Unveiling Discrepancies in Identifying Depression in Dementia: a Comparative Analysis of Caregiver and Patient Self-Report Measures.

Standard assessment of depression in research and clinical care with persons with dementia (PWD) relies on caregiver report, and views of PWD are typically not incorporated due to concerns that they lack insight into their own neuropsychiatric status. This study explored the discrepancies between self-reported and caregiver-reported depression among PWD. Participants included 373 PWD who met criteria for Alzheimer's disease, behavioral variant frontotemporal dementia, semantic variant primary progressive aphasia, and progressive supranuclear palsy. Each PWD self-reported depressive symptoms using the Geriatric Depression Scale (GDS), including subscales of dysphoria, withdrawal, worry, worthlessness, and cognitive concern. Caregivers described the PWD using the Neuropsychiatric Inventory (NPI) depression and apathy subscales. Of the total sample, 112 (30%) patients were positive for depression on both their self-report (GDS total > =13) and their informant report (NPI depression = yes). However, 226 (60.5%) patients self-reported depression on the GDS, including dysphoria and hopelessness, but their caregivers reported no depression. Additionally, 110 (49%) patients who self-reported depression but whose informants reported no depression were described as apathetic by their informants, compared to 43 (19%) of these depressed patients whose informants did not report depression or apathy. These results suggest that overreliance on caregivers' reports of depression may seriously underrepresent rates of depression in PWD and mischaracterize patients' experience. Difficulty distinguishing depression from apathy accounted for only part of this PWD-caregiver discrepancy. Prioritizing PWD self-report of mood, and broadening caregiver education about depression, may improve care and quality of life for PWD.

Neuropathological correlates of neuropsychiatric symptoms in dementia

AbstractBackgroundNeuropsychiatric symptoms (NPS) are very common in Lewy body dementias (LBD), but their aetiology is poorly understood. In a post‐mortem study we aimed to characterise the contribution of neuropathological substrates to some of the most common NPS in dementia.MethodParticipants who passed away between 2004 and 2021 underwent comprehensive neuropathologic evaluation at the Biobank for Aging Studies. Neuropathological data was collected for Lewy body neuropathology (LBD Braak score), neurofibrillary tangles (NFT Braak score), amyloid‐β burden (CERAD‐NP), TDP‐43, lacunar infarcts, cerebral amyloid angiopathy and hyaline atherosclerosis. Post‐mortem interviews were used to collect information regarding neuropsychiatric and cognitive status using the Neuropsychiatric Inventory (NPI) and Clinical Dementia Rating (CDR). A total of 948 cases were classified according to neuropathological assessment: (1) No pathology (NP) (n = 678); (2) Alzheimer’s Disease (AD) (n = 183); (3) LBD (n = 57); (4) AD+LBD (n = 30).ResultMultinomial logistic regression models comparing LBD, AD and AD+LBD to NP, adjusted for age, ethnicity, sex, and education level, showed significantly higher odds of hallucination and delusions across all groups compared to NP with the relative risk of hallucinations most elevated in AD+LBD cases (RRR = 19.3,[95%CI = 8.00‐46.3], p&lt;0.001). All groups had increased risk of higher NPI scores relative to NP, but the greatest increase was for AD+LBD (RRR = 1.04, [95%CI = 1.02‐1.06], p&lt;0.001). There were significantly greater risk of agitation and apathy in AD and AD+LBD groups relative to NP. (Table 1) Additionally, hallucinations were associated with higher Lewy body Braak scores (OR = 1.30, 95%CI = 1.13‐1.49, p&lt;0.001). Higher NFT Braak scores were associated with depression (OR = 1.28, 95%CI = 1.09‐1.50, p&lt;0.001), agitation (OR = 1.30, 95% CI = 1.07‐1.57, p = 0.009) and overall NPI score (IRR = 1.15, 95%CI = 1.05‐1.27, p = 0.004). Lacunar infarcts were associated with delusions (OR = 4.68, 95%CI = 1.12‐19.5, p = 0.03). More frequent neuritic plaques was inversely associated with apathy (OR = 0.70, 95%CI = 0.52‐0.93, p = 0.01). Cerebral amyloid angiopathy, hyaline atherosclerosis, and TDP‐43 did not associate with any of the neuropsychiatric symptoms in the multivariable logistic models. (Table 2)ConclusionLewy body pathology was the most significant contributor to the aetiology of hallucinations, while NFT were important contributors to depression and agitation in dementia. Supporting the dual importance of these pathologies, subjects with AD and LBD co‐pathology showed the greatest burden of NPS.

A Presentation of Rare Heidenhain-Variant Creutzfeldt-Jakob Disease

Heidenhain-variant Creutzfeldt-Jakob disease (HV-CJD) is a rare pathologic prion disease characterized by visual symptoms preceding progressive neurodegeneration and death. In HV-CJD, pathologic prions display demyelinating neurotropism for the occipital lobe, yielding characteristic visual changes and hallucinations. Herein, we describe the case of a patient who presented with antecedent visual hallucinations followed by declining neuropsychiatric status, startle myoclonus, gait ataxia, and personality change. Clinical symptoms, electroencephalography, magnetic resonance imaging, and lumbar puncture supported a diagnosis of HV-CJD. This case emphasizes the importance of multidisciplinary management for ruling out alternative medical diagnoses, performing appropriate diagnostic studies, and implementing patient-centered management.

Cushing’s Syndrome Presenting as Nonconvulsive Status Epilepticus: A Case Report and Literature Review (P9-1.011)

<h3>Objective:</h3> NA <h3>Background:</h3> Cushing’s Syndrome (CS) may present with neuropsychiatric manifestations that can mimic autoimmune encephalitis, potentially delaying diagnosis and treatment. We present a case of CS presenting with personality changes and status epilepticus and performed a literature review describing neurological manifestations of CS. <h3>Design/Methods:</h3> A male in his 50s presented with episodic word-finding difficulties, inappropriate smiling, fatigue, cognitive decline and one episode of generalized tonic clonic seizure on levetiracetam from an outside hospital. Workup revealed thrombocytopenia, hypokalemia, hypertension, normal MRI brain and sella. Continuous electroencephalogram revealed nonconvulsive status epilepticus. Lumbar puncture demonstrated elevated protein with normal white blood cell count. He was started on high-dose IV methylprednisolone followed by IVIg for presumed autoimmune encephalitis. Autoimmune encephalitis antibodies including anti-NMDA receptor were negative. CT PET scan showed bilateral adrenal enlargement, which in the context of hypokalemia, hyperglycemia, hypertension, and thrombocytopenia was concerning for severe Cushing’s Syndrome. Methylprednisolone and anti-seizure medications were stopped. Inferior petrosal sinus sampling and cerebral angiogram were unremarkable. The diagnosis was supported by elevated random and urine cortisol levels and managed with etomidate and ketoconazole. He underwent bilateral open adrenalectomy following which he was started on oral glucocorticoids. Repeat EEG showed no ictal activity and the patient remained seizure-free. <h3>Results:</h3> Literature review utilizing PubMed identified 17 articles describing CS presenting with neuropsychiatric symptoms. The most common symptoms cited were cognitive decline (23%), psychosis (18%) and seizure (6%). Additional isolated cases cited posterior reversible encephalopathy syndrome, hypogeusia and hyposmia. Most patients had significant improvement or full recovery once CS was treated. <h3>Conclusions:</h3> Cushing’s Syndrome can present with neuropsychiatric symptoms and status epilepticus. It can be an emergency requiring prompt endocrine and surgical evaluation. Serum cortisol levels should be checked in patients presenting with acute personality changes and seizures. <b>Disclosure:</b> Dr. Cameron has nothing to disclose. Dr. Venegas has nothing to disclose. Dr. Fahad has nothing to disclose. Dr. Mathew has nothing to disclose.

The effect of responsive neurostimulation (RNS) on neuropsychiatric and psychosocial outcomes in drug-resistant epilepsy

ObjectiveThe impact of responsive neurostimulation (RNS) on neuropsychiatric and psychosocial outcomes has not been extensively evaluated outside of the original clinical trials and post-approval studies. The goal of this study was to ascertain the potential real-world effects of RNS on cognitive, psychiatric, and quality of life (QOL) outcomes in relation to seizure outcomes by examining 50 patients undergoing RNS implantation for drug-resistant epilepsy (DRE). MethodsWe performed a retrospective review of all patients treated at our institution with RNS for DRE with at least 12 months of follow-up. In addition to baseline demographic and disease-related characteristics, we collected cognitive (Full-Scale Intelligence Quotient, Verbal Comprehension, and Perceptual Reasoning Index), psychiatric (Beck Depression and Anxiety Inventory Scores), and QOL (QOLIE-31) outcomes at 6 and 12 months after RNS implantation and correlated them with seizure outcomes. ResultsFifty patients (median age 39.5 years, 64% female) were treated with RNS for DRE in our institution from 2005 to 2020. Of the 37 of them who had well-documented pre and post-implantation seizure diaries, the 6-month median seizure frequency reduction was 88%, the response rate (50% or greater seizure frequency reduction) was 78%, and 32% of patients were free of disabling seizures in this timeframe. There was no statistically significant difference at a group level in any of the evaluated cognitive, psychiatric, and QOL outcomes at 6 and 12 months post-implantation compared to the pre-implantation baseline, irrespective of seizure outcomes, although a subset of patients experienced a decline in mood or cognitive variables. SignificanceResponsive neurostimulation does not appear to have a statistically significant negative or positive impact on neuropsychiatric and psychosocial status at the group level. We observed significant variability in outcome, with a minority of patients experiencing worse behavioral outcomes, which seemed related to RNS implantation. Careful outcome monitoring is required to identify the subset of patients experiencing a poor response and to make appropriate adjustments in care.

Assessing the Costs of Neuropsychiatric Disease in the Systemic Lupus International Collaborating Clinics Cohort Using Multistate Modeling.

To estimate direct and indirect costs associated with neuropsychiatric (NP) events in the Systemic Lupus International Collaborating Clinics inception cohort. NP events were documented annually using American College of Rheumatology definitions for NP events and attributed to systemic lupus erythematosus (SLE) or non-SLE causes. Patients were stratified into 1 of 3 NP states (no, resolved, or new/ongoing NP event). Change in NP status was characterized by interstate transition rates using multistate modeling. Annual direct costs and indirect costs were based on health care use and impaired productivity over the preceding year. Annual costs associated with NP states and NP events were calculated by averaging all observations in each state and adjusted through random-effects regressions. Five- and 10-year costs for NP states were predicted by multiplying adjusted annual costs per state by expected state duration, forecasted using multistate modeling. A total of 1,697 patients (49% White race/ethnicity) were followed for a mean of 9.6 years. NP events (n=1,971) occurred in 956 patients, 32% attributed to SLE. For SLE and non-SLE NP events, predicted annual, 5-, and 10-year direct costs and indirect costs were higher in new/ongoing versus no events. Direct costs were 1.5-fold higher and indirect costs 1.3-fold higher in new/ongoing versus no events. Indirect costs exceeded direct costs 3.0 to 5.2 fold. Among frequent SLE NP events, new/ongoing seizure disorder and cerebrovascular disease accounted for the largest increases in annual direct costs. For non-SLE NP events, new/ongoing polyneuropathy accounted for the largest increase in annual direct costs, and new/ongoing headache and mood disorder for the largest increases in indirect costs. Patients with new/ongoing SLE or non-SLE NP events incurred higher direct and indirect costs.

Neuropsychiatric Status of Patients With Multiple Sclerosis Across Disease Duration Intervals.

The neuropsychiatric sequelae of multiple sclerosis (MS) are important predictors of morbidity and mortality. The authors examined how symptoms of depression, anxiety, fatigue, subjective cognitive impairment, and objective cognitive dysfunction varied with disease duration. They also explored changes in the use of disease-modifying therapies, psychotropic medications, and psychotherapies in relation to disease duration. A retrospective sample of 464 people with MS was stratified into three groups based on disease duration: <5 years (N=129), 5-10 years (N=101), and >10 years (N=234). Symptoms of depression and anxiety were recorded with the Hospital Anxiety and Depression Scale (HADS); fatigue, with the five-item version of the Modified Fatigue Impact Scale (MFIS-5); subjective cognitive impairment, with the five-item version of the Perceived Deficits Questionnaire (PDQ-5); and cognition, with the Minimal Assessment of Cognitive Function in MS (MACFIMS). There were between-group differences in anxiety symptoms (p<0.01) and degree of cognitive impairment (p=0.03), but there were no differences in depressive symptoms, fatigue, or subjective cognitive difficulties. Anxiety was higher during the first 5 years after diagnosis, and cognitive dysfunction was higher when assessed more than 10 years after diagnosis. With longer disease duration, a greater proportion of participants received psychotropic medications (p<0.01), and lower proportions received disease-modifying therapies (p<0.01) or psychotherapies (p<0.01). Findings indicated that rates of some neuropsychiatric symptoms, such as anxiety and cognitive dysfunction, may shift with disease duration, whereas other symptoms, such as fatigue and depression, may not. These findings highlight the importance of closely monitoring the mental state of people with MS over time.

Leisure-Related Social Work Interventions for Patients with Cognitive Impairment: A Systematic Review and Meta-Analysis.

The social work profession has been exploring nonpharmacological interventions for patients with cognitive impairment, but there are few evidence-based research outputs. Systematically evaluating the effectiveness of social work interventions for people with cognitive impairment can shed light on the matter to further improve similar interventions. Randomized controlled trials of nonpharmacological interventions for patients with cognitive impairment were selected from key literature databases in both English and Chinese from 2010 to 2021. A systematic review and meta-analysis with Revman 5.4 were performed. Seven trials were included, involving 851 patients with cognitive impairment. The meta-analysis showed that, in terms of overall cognitive function, the Montreal Cognitive Assessment score (MD = 1.64, 95% CI [0.97, 2.30], p < 0.001) of the intervention group was superior to the control group, but there was no significant difference in the Mini-Mental State Examination score between the two groups (MD = 0.33, 95% CI [-0.16, 0.82], p = 0.18). Compared with the control group, nonpharmacological intervention can effectively improve the neuropsychiatric condition of patients (SMD = -0.42, 95% CI [-0.64, -0.20], p = 0.0002). In summary, the current evidence shows that nonpharmacological social work interventions had a positive effect on the cognitive function and neuropsychiatric status of patients with cognitive impairment. Suggestions for future nonpharmacological intervention practice are discussed.

Clinical and neurophysiological parameters in patients with epilepsy in the long-term period after COVID-19

Clinical and psychophysiological assessment of the dynamics of the condition of patients with epilepsy in 4-6 months after the coronavirus infection. An open controlled prospective comparative outpatient clinical and physiological study of patients diagnosed with epilepsy after suffering from COVID-19 (after 4-6 months) of moderate severity (n=16), patients diagnosed with epilepsy who did not suffer from COVID-19 (n=7), a control group (n=11) after confirmed COVID-19 (after 4-6 months). All groups were in the age range 23 to 50 years. Clinical/neurological and somatic research included: anamnesis, neurological examination, questioning, ECG, EEG, clinical and psychometric tests. There was an increase in the representation of epileptiform activity in the background EEG and more pronounced activity in provoking samples compared with background recording in 26.5% of patients who had suffered COVID-19 compared with the group of patients with epilepsy who had not suffered COVID-19. The detection of rare epileptic seizures in 18.8% of cases in the group of epilepsy patients, who underwent COVID-19, indicates an increase in epileptogenesis and a decrease in therapeutic control over seizures. At the same time, 87.5% of patients in this group showed a statistically significant increase in the influence of the sympathetic nervous system on the regulation of heart rhythm and an increase in anxiety and depression. The results can complement the understanding of the neuropsychiatric status of patients with epilepsy after COVID-19, which provides prerequisites for the development of optimal recovery directions in the rehabilitation period to maintain drug remission of epilepsy and reduce the possible progression of the disease.

Evaluation of cognitive functions in adult individuals with COVID-19.

Cognitive deficits that are associated with coronavirus disease 2019 (COVID-19) and occur in the acute period are gaining importance. While most studies have focused on the elderly severely affected during acute infection, it remains unclear whether mild to moderate COVID-19 results in cognitive deficits in young patients. This study aims to evaluate the post-infection cognitive functions of young adults with mild to moderate symptoms of COVID-19. A total of 100 adults with similar age and educational background were included in the study. Half of those had been infected with COVID-19 in the last 60days (N = 50), and the other half had not (N = 50). Global cognitive skills of the participants were evaluated through Montreal Cognitive Assessment Scale (MoCA) and Clock-Drawing Test; memory functions with Öktem Verbal Memory Processes Test (Ö-VMPT); attention span with Digit Span Test; executive functions with Fluency Tests, Stroop Test, and Trail Making Test; visual perceptual skills with Rey Osterrieth Complex Figure Test (ROCF); and neuropsychiatric status with Neuropsychiatric Inventory (NPI). Evaluations were performed in the experimental group for 21 to 60days from the onset of the disease, and throughout the study, in the control group. It was found that global cognitive skills, verbal memory, visual memory, executive function, and neuropsychiatric status were affected during COVID-19 (p < 0.05). When the cases were analyzed according to disease severity, no relationship was found between cognitive deficits and disease severity.