Severe Cognitive Impairment Group Research Articles

EEG biomarkers analysis in different cognitive impairment after stroke: an exploration study.

Stroke is a cerebrovascular illness that brings about the demise of brain tissue. It is the third most prevalent cause of mortality worldwide and a significant contributor to physical impairment. Generally, stroke is triggered by blood clots obstructing the brain's blood vessels, or when these vessels rupture. And, the cognitive impairment's evaluation and detection after stroke is crucial research issue and significant project. Thus, the objective of this work is to explore an potential neuroimage tool and find their EEG biomarkers to evaluate and detect four cognitive impairment levels after stroke. In this study, power density spectrum (PSD), functional connectivity map, and one-way ANOVA methods were proposed to analyze the EEG biomarker differences, and the number of patient participants were thirty-two human including eight healthy control, mild, moderate, severe cognitive impairment levels, respectively. Finally, healthy control has significant PSD differences compared to mid, moderate and server cognitive impairment groups. And, the theta and alpha bands of severe cognitive impairment groups have presented consistent superior PSD power at the right frontal cortex, and the theta and beta bands of mild, moderated cognitive impairment (MoCI) groups have shown significant similar superior PSD power tendency at the parietal cortex. The significant gamma PSD power difference has presented at the left-frontal cortex in the mild cognitive impairment (MCI) groups, and severe cognitive impairment (SeCI) group has shown the significant PSD power at the gamma band of parietal cortex. At the point of functional connectivity map, the SeCI group appears to have stronger functional connectivity compared to the other groups. In conclusion, EEG biomarkers can be applied to classify different cognitive impairment groups after stroke. These findings provide a new approach for early detection and diagnosis of cognitive impairment after stroke and also for the development of new treatment options.

Spontaneous brain activity in the hippocampal regions could characterize cognitive impairment in patients with Parkinson's disease.

This study aimed to investigate whether spontaneous brain activity can be used as a prospective indicator to identify cognitive impairment in patients with Parkinson's disease (PD). Resting-state functional magnetic resonance imaging (RS-fMRI) was performed on PD patients. The cognitive level of patients was assessed by the Montreal Cognitive Assessment (MoCA) scale. The fractional amplitude of low-frequency fluctuation (fALFF) was applied to measure the strength of spontaneous brain activity. Correlation analysis and between-group comparisons of fMRI data were conducted using Rest 1.8. By overlaying cognitively characterized brain regions and defining regions of interest (ROIs) based on their spatial distribution for subsequent cognitive stratification studies. A total of 58 PD patients were enrolled in this study. They were divided into three groups: normal cognition (NC) group (27 patients, average MoCA was 27.96), mild cognitive impairment (MCI) group (21 patients, average MoCA was 23.52), and severe cognitive impairment (SCI) group (10 patients, average MoCA was 17.3). It is noteworthy to mention that those within the SCI group exhibited the most advanced chronological age, with an average of 74.4 years, whereas the MCI group displayed a higher prevalence of male participants at 85.7%. It was found hippocampal regions were a stable representative brain region of cognition according to the correlation analysis between the fALFF of the whole brain and cognition, and the comparison of fALFF between different cognitive groups. The parahippocampal gyrus was the only region with statistically significant differences in fALFF among the three cognitive groups, and it was also the only brain region to identify MCI from NC, with an AUC of 0.673. The paracentral lobule, postcentral gyrus was the region that identified SCI from NC, with an AUC of 0.941. The midbrain, hippocampus, and parahippocampa gyrus was the region that identified SCI from MCI, with an AUC of 0.926. The parahippocampal gyrus was the potential brain region for recognizing cognitive impairment in PD, specifically for identifying MCI. Thus, the fALFF of parahippocampal gyrus is expected to contribute to future study as a multimodal fingerprint for early warning.

Presence and Characteristics of Behavioral and Psychological Symptoms in Subacute Stroke Patients with Cognitive Impairment.

This retrospective cross-sectional study is aimed at investigating the prevalence and characteristics of behavioral and psychological symptoms (BPS) in subacute stroke patients with cognitive impairment. The Neuropsychiatric Inventory-Questionnaire (NPI-Q) was used to assess BPS. A total of 358 consecutive patients with first-ever stroke admitted to rehabilitation wards and with Mini-Mental State Examination (MMSE) scores < 24 on admission were included. BPS was defined as a total NPI-Q Severity or Distress score ≥ 1. Differences between the severity and presence of BPS among patients with severe cognitive impairment (MMSE scores 0-17) and those with mild cognitive impairment (MMSE scores 18-23) were analyzed using the Mann-Whitney U test and chi-squared test, respectively. Eighty-one patients (mean (standard deviation) age, 73.5 (13.1) years) were enrolled for analysis. BPS were observed in 69.1% and 74.1% of patients when assessed with NPI-Q Severity and NPI-Q Distress, respectively. The most frequently observed BPS was apathy, followed by depression (approximately 44% and 40%, respectively). The severity and frequency of delusions, euphoria, apathy, and disinhibition were significantly higher in the severe cognitive impairment group than in the mild cognitive impairment group. However, the severity, distress, and frequency of depression were not dependent on the severity of cognitive impairment. The presence of BPS, especially apathy and depression, in subacute stroke patients with cognitive impairment is high. The severity and frequency of some BPS are higher in patients with severe cognitive impairment than in those with mild cognitive impairment. However, depression is highly prevalent among the patients regardless of the severity of cognitive impairment.

Validation and application of the Chinese version of the Columbia-Suicide Severity Rating Scale: Suicidality and cognitive deficits in patients with major depressive disorder

BackgroundDepression is a significant risk factor for death by suicide. Additionally, patients with depression who have neurocognitive dysfunction are at a higher risk of exhibiting suicidal behaviors. We aimed to validate the Chinese version of the Columbia Suicide Severity Rating Scale (C-SSRS) and then employ it to examine the association between suicidality and cognitive deficits in patients with Major Depressive Disorder (MDD). MethodsData from 456 patients with MDD who underwent baseline assessment and 3-month follow-up were used for psychometric validation of the C-SSRS. 430 patients were divided into a mild cognitive impairment group (N = 390) and a severe cognitive impairment group (N = 40) using cluster analysis and compared with healthy controls. The relationship between C-SSRS scores and the degree of cognitive impairment was analyzed. Results1) The Chinese version of C-SSRS demonstrated good internal consistency (Cronbach's alpha = 0.884/0.842), convergent and divergent validity. 2) The severity of suicidal ideation (SI), the intensity of SI, and the lifetime history of suicide attempts were significant independent predictors of short-term suicide attempts. 3) Higher worst-point lifetime SI severity and intensity scores in patients with MDD were significantly associated with severe cognitive impairment. LimitationsThe analysis of cognition and suicide was based on cross-sectional studies. Hence, changes in SI and cognitive function over time could not be analyzed. ConclusionsThe Chinese C-SSRS is a reliable and valid assessment tool for suicidal ideation and behavior in patients with depression. Suicidal ideation in patients with MDD is associated with cognitive dysfunction. These findings provide a reference for suicide prevention in patients with depression.

Relationships between quantitative retinal microvascular characteristics and cognitive function based on automated artificial intelligence measurements.

Introduction: The purpose of this study is to assess the relationship between retinal vascular characteristics and cognitive function using artificial intelligence techniques to obtain fully automated quantitative measurements of retinal vascular morphological parameters. Methods: A deep learning-based semantic segmentation network ResNet101-UNet was used to construct a vascular segmentation model for fully automated quantitative measurement of retinal vascular parameters on fundus photographs. Retinal photographs centered on the optic disc of 3107 participants (aged 50-93years) from the Beijing Eye Study 2011, a population-based cross-sectional study, were analyzed. The main parameters included the retinal vascular branching angle, vascular fractal dimension, vascular diameter, vascular tortuosity, and vascular density. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Results: The results showed that the mean MMSE score was 26.34 ± 3.64 (median: 27; range: 2-30). Among the participants, 414 (13.3%) were classified as having cognitive impairment (MMSE score < 24), 296 (9.5%) were classified as mild cognitive impairment (MMSE: 19-23), 98 (3.2%) were classified as moderate cognitive impairment (MMSE: 10-18), and 20 (0.6%) were classified as severe cognitive impairment (MMSE < 10). Compared with the normal cognitive function group, the retinal venular average diameter was significantly larger (p = 0.013), and the retinal vascular fractal dimension and vascular density were significantly smaller (both p < 0.001) in the mild cognitive impairment group. The retinal arteriole-to-venular ratio (p = 0.003) and vascular fractal dimension (p = 0.033) were significantly decreased in the severe cognitive impairment group compared to the mild cognitive impairment group. In the multivariate analysis, better cognition (i.e., higher MMSE score) was significantly associated with higher retinal vascular fractal dimension (b = 0.134, p = 0.043) and higher retinal vascular density (b = 0.152, p = 0.023) after adjustment for age, best corrected visual acuity (BCVA) (logMAR) and education level. Discussion: In conclusion, our findings derived from an artificial intelligence-based fully automated retinal vascular parameter measurement method showed that several retinal vascular morphological parameters were correlated with cognitive impairment. The decrease in retinal vascular fractal dimension and decreased vascular density may serve as candidate biomarkers for early identification of cognitive impairment. The observed reduction in the retinal arteriole-to-venular ratio occurs in the late stages of cognitive impairment.

Cognitive function level and chronic disease incidence rate by age of older adults living in the community

AbstractBackgroundResearch has shown that decline in cognitive function is related to the level of chronic disease in old age. Most studies, however, have either examined limited aspects of cognitive function or used assessment tools with low accuracy. A limited range of cognitive function items and low‐accuracy cognitive function assessment tools may bias the findings. Current literature also has paid little attention to the age‐gradient association between cognitive function and chronic diseases. Utilizing a new cognitive classification method, this study investigated cognitive function‐associated chronic diseases and their relationship with age. Empirical knowledge about the dynamic among cognitive function, changes in chronic diseases, and age may contribute to establishing comprehensive prevention and management programs of diseases in later years.MethodA total of 6,940 people aged between 55 to 105 years from the 2018 Korean Longitudinal Study of Aging panel data were included in this study. According to the Korean Mini‐Mental State Examination’s total score and instrumental activities of daily living assistance, cognitive status was classified into normal cognition, moderate cognitive impairment, and severe cognitive impairment. The Poisson regression analysis was used to calculate the incident rate ratios (IRR) of cognitive status by age and the incidence of chronic diseases.ResultThe incidence rate of chronic diseases was 1.07 times higher in the moderate cognitive impairment group (n = 4665) than in the normal cognitive group (n = 4665). In addition, it was 1.24 times higher in the severe cognitive impairment group (n = 420) than in the normal cognitive group (Table 1) and the incidence of chronic diseases according to cognitive function increased with age (figure 1).ConclusionApplying the new cognitive function classification, we found the incidence rate of age‐related chronic diseases increased with the cognitive status, indicating incidence of chronic diseases increases as the cognitive state decreases and the age increases, leading to complex chronic conditions. This finding points to the importance of an integrated program of cognitive decline prevention and the chronic disease management program, which are currently developed and implanted separately.

Sleep Parameters and Plasma Biomarkers for Cognitive Impairment Evaluation in Patients With Cerebral Small Vessel Disease.

Cognitive impairment caused by cerebrovascular disease accounts for more than half of vascular dementia. However, neuropsychological tests are limited by their subjectivity. Additional effective approaches to evaluate cognitive impairment in patients with cerebrovascular disease are necessary. One hundred and thirty-two patients with cerebrovascular disease were recruited. One hundred participants met the criteria and completed neuropsychological scales. Sixty-nine participants proceeded with polysomnography, and 63 of them had their peripheral blood biomarkers measured. According to Mini-Mental State Examination scores, patients were divided into cognitively impaired and cognitively normal groups. The differences in biomarkers and sleep parameters between the groups were compared, and decision tree models were constructed to evaluate the evaluation ability of these indicators on cognitive decline. The integrated decision tree model of sleep parameters yielded an area under curve (AUC) of 0.952 (95% confidence interval [CI]: 0.911-0.993), while that of plasma biomarkers yielded an AUC of 0.872 (95% CI: 0.810-0.935) in the assessment of cognition status. Then the participants were automatically clustered into mild and severe cognitive impairment groups by multiple neuropsychological test results. The integrated plasma biomarker model showed an AUC of 0.928 (95% CI: 0.88-0.977), and the integrated sleep parameter model showed an AUC of 0.851 (95% CI: 0.783-0.919) in the assessment of mild/severe cognitive impairment. Integrated models which consist of sleep parameters and plasma biomarkers can accurately evaluate dementia status and cognitive impairment in patients with cerebral small vessel disease. This innovative study may facilitate drug development, early screening, clinical diagnosis, and prognosis evaluation of the disease.

Factors Influencing Post-Stroke Cognitive Impairment in Patients with Type 2 Diabetes Mellitus.

ObjectiveType 2 diabetes mellitus (T2DM) and ischemic stroke, which are common diseases among older people, are closely related to cognitive impairment. This study aims to investigate the influencing factors of post-stroke cognitive impairment (PSCI) in patients with T2DM.MethodsWe enrolled 161 patients with T2DM who experienced acute ischemic stroke and were hospitalized in the Department of Neurology, Jinan Central Hospital, Shandong, China. Cognitive function was evaluated with the Montreal Cognitive Assessment scale. According to the results, patients were divided into three groups—the cognitively normal group, mild cognitive impairment group, and severe cognitive impairment group. We analyzed general demographic data, laboratory information, imaging data, the results of neuropsychological evaluation, and clinical features as well as influencing factors of PSCI in these patients and established a prediction model.ResultsThe three groups of patients were significantly different in terms of age, education level, course of diabetes mellitus (DM), recurrent cerebral infarction (RCI), and other factors. RCI, course of DM, and glycated hemoglobin (HbA1c) were independent risk factors of PSCI in patients with T2DM, with odds ratio (95% confidence interval): 7.17 (2.09, 30.37), 5.39 (2.40, 14.59), and 3.89 (1.66, 10.04), respectively, whereas female, senior high school, serum albumin were protective factors: 0.28 (0.07, 0.95), 0.05 (0.01, 0.21), 0.20 (0.08, 0.42), respectively. Furthermore, we constructed a prediction model using sex, age, education level, RCI, DM course, HbA1c and serum albumin and obtained a receiver operating characteristic (ROC) curve. The area under the ROC curve is 0.966, suggesting the significant association of these influencing factors with PSCI in patients with T2DM.ConclusionIn this study, the occurrence of PSCI in patients with T2DM was related to RCI, course of DM, and HbA1c, among other factors. Attention to influencing factors is needed in these patients for early diagnosis and timely intervention of cognitive impairment.

Study on Correlation between Body Cell Mass Index and Cognitive Impairment in Hemodialysis Maintaining Patients: A Cross-Sectional Study.

Objective To investigate the relationship between body cell mass index (BCMI) and cognitive impairment in maintaining hemodialysis (MHD) patients. Methods We collected the general materials, laboratory indexes, and physical measurement indexes of patients undergoing maintenance hemodialysis in hemodialysis centers of 20 tertiary and tertiary general hospitals in Guizhou Province from June to September 2020. The body composition was measured by bioelectrical impedance method, and the BCMI value was calculated. The subjects were divided into normal cognitive function group (score ≥27), mild cognitive impairment group (score 23–26), and severe cognitive impairment group (score <23). Two groups of people with normal cognitive function and cognitive impairment with similar baseline data (gender, age, and education) were obtained by propensity score matching (PSM). Results A total of 2008 subjects were included in this study, including 467 cases (23.3%) in the cognitive impairment group. A total of 814 cases were accurately matched after PSM. Multivariate logistic regression analysis showed that the incidence risk of the BCMI Q1 group was 8.99 times higher than that of the Q4 group (95% CI: 5.74 ∼ 14.09, P < 0.001). ROC curve analysis showed that the best threshold of BCMI for predicting cognitive impairment in MHD patients was 9.05, the sensitivity and specificity were 71.5% and 62.7%, respectively, and the area under the curve was 0.713 (95% CI: 0.678 ∼ 0.748, P < 0.001). Conclusions BCMI is related to cognitive impairment in MHD patients and has predictive value for the onset of cognitive impairment in MHD patients.

UPSA: avaliação do desempenho funcional nos diferentes estádios de declínio cognitivo

Introduction: Dementia is an acquired clinical syndrome, characterized by a progressive decline of several cognitive areas. Deficits are persistent and severe enough to interfere with social relations and with the ability to perform independently the activities of daily living. Several studies showed that impairment in instrumental activities of daily living (IADL) predict significantly dementia development. In order to evaluate IADL, performance-based instruments showed to be more sensitive differentiating cognitive healthy subjects from cognitive impairment subjects. Aims: To translate and adapt the second version of UCSD-Performance-Based Skills Assessment (UPSA-2), a performance-based instrument developed for assessing IADL and to verify if exists differences in functional ability in the different stages of cognitive decline. Materials and methods: The sample was composed by 81 subjects, 34 subjects from the cognitively healthy group, 23 from the mild cognitive impairment group and 24 from the severe cognitive impairment group. The subjects were distributed between the groups according to the established inclusion criteria. Results: UPSA-2 final results were significantly lower in severe cognitive impairment subjects, more than mild cognitive impairment subjects, which in turn were lower than cognitively healthy subjects. UPSA-2 final result is strongly correlated with the Alzheimer’s Disease Cooperative Study scale, Cognitive sub-scale (ADAS-Cog) (r=-0.84/p<0.001). We also have verified that subjects without functional impairments in IADL scale, showed impairments in the UPSA-2 several domains. Conclusions: UPSA-2 is a functional assessment tool that discriminates the functional performance of cognitively healthy subjects, from the performance of mild and severe cognitive impairment subjects. This study showed that UPSA-2 has more sensibility in IADL assessment, than a self-report measure. Also, highlights the strong association between cognitive and functional performance.

Levels of serum S100B are associated with cognitive dysfunction in patients with type 2 diabetes.

Objective: Previous studies have provided robust evidence that cognitive impairment exists in patients with type 2 diabetes. The predictive role of S100B in a variety of neurodegenerative diseases such as Alzheimer’s disease, has been shown to be closely related to cognitive function. The purpose of this study was to investigate the correlation between serum S100B levels and cognitive function in type 2 diabetes patients.Results: The type 2 diabetes group scored lower than the healthy control group in all domains of cognitive function except language and attention, and the former group also had lower serum levels of S100B. Besides, serum S100B levels were lower in the type 2 diabetes patients with impaired cognition than in those with normal cognition. In addition, the moderate to severe cognitive impairment group had significantly lower levels than that in mild cognitive impairment group. After adjusting for confounding factors, serum S100B levels were positively correlated with cognitive function in type 2 diabetes patients.Conclusions: Serum S100B levels were positively correlated with cognitive function in type 2 diabetes patients with cognitive impairment. It is suggested that S100B may be involved in the occurrence and development of cognitive dysfunction in type 2 diabetes patients and play a protective role.Methods: The clinical data and biochemical indexes of ninety-six patients with type 2 diabetes and sixty-eight healthy subjects were collected. The levels of serum S100B were detected by enzyme-linked immunosorbent assay. Ninety-six type 2 diabetes patients were divided into a cognitive dysfunction group and a normal cognition group according to Mini-mental State Examination scores. To better understand the differences in various aspects of cognition, we used the Repeatable Battery for the Assessment of Neuropsychological Status scale for further evaluation. To study the relationship between serum S100B levels and cognitive impairment, the cognitive dysfunction group was divided into a mild cognitive impairment group and a moderate to severe cognitive impairment group for further study.

Early cognitive dysfunction as a marker for the poor course of multiple sclerosis: a prospective 12-year follow-up

Owing to the advent of current methods for the prevention of exacerbations of multiple sclerosis (MS), it has become possible to increase the period to the development of obvious persistent cerebellar and motor disorders that mainly lead to disability. This makes it possible to focus on less evident and latent symptoms, in particular on cognitive impairment (CI) that are recorded since the diagnosis of MS and slowly progress over time.Objective: to assess the prognostic capabilities of the Paced Auditory Serial Addition Test (PASAT) to identify a group of patients with early disability (10-year risk of reaching 6.5 Expanded Disability Status Scale (EDSS) scores.Patients and methods. The paper presents the data of a 12-year (2005–2018) follow-up of 36 patients having MS with and without mild CI. The patients' mean age at the time of study inclusion was 31.7 years (confidence interval (CI) 29.2–34.1; α&lt;0.05); the disease duration was 4.69 months (CI 3.31–6.08; α&lt;0.05); the EDSS scores averaged 2.51 (CI 2.23–2.82; α&lt;0.05). Severe disability (6.5 EDSS scores) was observed in 75% of cases in the presence of mild CI and in 25% of cases in the absence of mild CI; it occurred an average of 118.3 (CI 93.1–143.4; α&lt;0.05) and 141.2 (CI 126.0–156.5; α&lt;0.05) months later, respectively.Results and discussion. The findings suggest that the patients with MS in the presence of impaired information processing speed and decreased attentional function (failure to complete more than 25% of the PASAT tasks) had a significantly greater risk for persistent disability than the patients without CI or with its minimal manifestations. Limitation in walking function (4.5 EDSS scores) occurred an average of 3.5 years earlier, and its significant limitation (6.5 EDSS scores) did 2 years earlier in the severe CI group, which may be important in planning therapy.Conclusion. The presence of CI in early MS is likely to have a prognostic value in relation to the course of the disease.

Association of lipoprotein a, fibrinogen and D-dimer with vascular cognitive impairment in patients with ischemic cerebral small vessel diseases

Objective To explore the correlation between lipoprotein a (Lpa), fibrinogen (FIB) and D-dimer (D-D) and vascular cognitive impairment in patients with ischemic cerebral small vessel diseases (CSVD). Methods Totally 300 patients with ischemic CSVD who were admitted to the Department of Neurology, Affiliated Hospital of North China University of Science and Technology were selected as the research objects, and 70 healthy outpatients in the same period were selected as the control group.Cognitive function was assessed with Mini Mental State Examination(MMSE). According to the results of MMSE, patients with ischemic CSVD were divided into cognitive normal group (106 cases) and cognitive impairment group (194 cases). The cognitive impairment group was further divided into mild cognitive impairment group (100 cases), moderate cognitive impairment group (60 cases) and severe cognitive impairment group (34 cases). Lpa level was detected by latex immunoturbidimetry, FIB level by coagulation and D-D level by ELISA.The results were compared and analyzed. Results (1) Compared with the control group (Lpa: (101.67±37.37)mg/L, FIB: (3.02±0.67) g/L, D-D: (231.49±95.00) mg/L), the levels of Lpa, FIB and D-D in normal group(Lpa: (150.58±89.55) mg/L, FIB: (3.48±0.80) g/L, D-D: (287.79±125.25)mg/L)and cognitive impairment group(Lpa: (257.98±189.23)mg/L , FIB: (3.86±0.97) g/L, D-D: (347.23±120.69) mg/L)increased significantly (all P<0.01). Compared with the cognitive normal group, the levels of Lpa, FIB and D-D in cognitive impairment group increased significantly (all P<0.01). (2) Compared with mild cognitive impairment group (Lpa: 169.08±51.63 mg/L, FIB: (3.10±0.69)g/L, D-D: (288.91±92.58)mg/L), the levels of Lpa, FIB and D-D of in moderate cognitive impairment group (Lpa: (236.78±107.15) mg/L, FIB: (3.52±0.67) g/L, D-D: (345.03±132.68) mg/L), severe cognitive impairment group (Lpa: (292.65±108.19) mg/L, FIB: (4.04±1.08) g/L, D-D: (401.58±84.87) mg/L) increased significantly (all P<0.01). Compared with the moderate cognitive impairment group, the levels of Lpa, FIB and D-D in the severe cognitive impairment group increased significantly (all P<0.01). (3) The ROC curve was fitted with cognitive impairment as state variable.The area under the ROC curve of Lpa was 0.706, P<0.01, 95% CI was (0.646-0.766), the area under the ROC curve of FIB was 0.613, P=0.001, 95% CI was (0.548-0.679), and the area under the ROC curve of D-D was 0.670, P<0.01, 95% CI was (0.604-0.736). (4) Lpa, FIB and D-D were positively correlated with the degree of cognitive impairment in patients with ischemic cerebral small vessel diseases (rLpa=0.522, P<0.01; rFIB=0.410, P<0.01; rD-D=0.488, P<0.01). Conclusion Serum Lpa, FIB and D-D are closely related to the degree of vascular cognitive impairment and cognitive impairment in patients with ischemic CSVD, which may be involved in the occurrence and development of cognitive impairment.Detection of serum levels of Lpa, FIB and D-D is of great clinical value in the early diagnosis, assessment and treatment of cognitive impairment in ischemic CSVD. Key words: Ischemic cerebral small vessel diseases; Vascular cognitive impairment; Lipoprotein a; Fibrinogen; D-dimer

Reduced Pain Reports With Increasing Cognitive Impairment in Older Persons in New Zealand.

Conflicting findings prevail about pain in older persons with cognitive impairment. There is evidence of changed pain perception; however, pain is also underrecognized. Pain and cognitive impairment were examined in a national cohort of older persons assessed using the Home Care International Residential Assessment Instrument (interRAI-HC). Participants were 41 459 aged 65+ years receiving a mandated needs assessment to access publicly funded services. InterRAI-HC pain severity and Cognitive Performance Scale analyses covaried for age, gender, and ethnicity. Milder pain prevalence increased with age, whereas daily severe-excruciating pain prevalence decreased with age. Daily severe-excruciating pain was reported by 18% of cognitively intact individuals decreasing to 8% in the severe cognitive impairment group. This relationship remained after covarying for age, sex, and ethnicity. Differences among dementia subtypes were found. Although severe pain reports decrease with increasing age and cognitive impairment, more nuanced research covarying for dementia severity and subtype is required.

Tau Protein in Oral Mucosa and Cognitive State: A Cross-sectional Study.

Neurodegenerative diseases are characterized by the presence of abnormal aggregates of proteins in brain tissue. Among them, the presence of aggregates of phosphorylated Tau protein (p-Tau) is the hallmark of Alzheimer’s disease (AD) and other major neurodegenerative disorders such as corticobasal degeneration and frontotemporal dementia among others. Although Tau protein has previously been assumed to be exclusive to the central nervous system, it is also found in peripheral tissues. The purpose of this study was to determine whether there is a differential Tau expression in oral mucosa cells according to cognitive impairment. Eighty-one subjects were enrolled in the study and classified per Mini-Mental State Examination test score into control, mild cognitive impairment (MCI), and severe cognitive impairment (SCI) groups. Immunocytochemistry and immunofluorescence revealed the presence of Tau and four p-Tau forms in the cytoplasm and nucleus of oral mucosa cells. More positivity was present in subjects with cognitive impairment than in control subjects, both in the nucleus and cytoplasm, in a speckle pattern. The mRNA expression of Tau by quantitative real-time polymerase chain reaction was higher in SCI as compared with the control group (P < 0.01). A significantly higher percentage of immunopositive cells in the SCI group was found via flow cytometry in comparison to controls and the MCI group (P < 0.01). These findings demonstrate the higher presence of p-Tau and Tau transcript in the oral mucosa of cognitively impaired subjects when compared with healthy subjects. The feasibility of p-Tau quantification by flow cytometry supports the prospective analysis of oral mucosa as a support tool for screening of proteinopathies in cognitively impaired patients.

The Reciprocal Causal Relationship between Social Activities and Health with Reference to the Cognitive Function Level among Community-dwelling Older Adults: A Cross-Lagged Panel Analysis

Purpose: The aim of this study is to examine the reciprocal causal relationship between social activities and health with reference to the cognitive function level among community-dwelling older adults. Methods: We conducted a longitudinal data analysis using the 4th (Time 1) and 5th (Time 2) waves from the Korean Longitudinal Study of Ageing adopting cross-lagged panel analysis (CLPA). Results: A total of 3,473 community-dwelling older adults were included in the analysis: 2,053 in the normal cognitive function group, 912 in the mild cognitive impairment group, and 508 in the moderate to severe cognitive impairment group. The CLPA revealed that higher levels of social activities at Time 1 significantly influenced better subjective health perception at Time 2 in all three groups. In addition, better subjective health perception at Time 1 significantly influenced higher levels of social activities at time 2 only in the normal cognitive function group. Conclusion: This study demonstrates that participating in social activities has positive effects on health regardless of the cognitive function level in community-dwelling older adults. This finding suggests that there is a need to develop strategies that can be used to encourage older adults with cognitive decline to maintain participation in social activities.

The Test Your Memory cognitive screening tool: sociodemographic and cardiometabolic risk correlates in a population-based study of older British men.

ObjectiveThis study aimed to examine the association of Test Your Memory (TYM)‐defined cognitive impairment groups with known sociodemographic and cardiometabolic correlates of cognitive impairment in a population‐based study of older adults.MethodsParticipants were members of the British Regional Heart Study, a cohort across 24 British towns initiated in 1978–1980. Data stemmed from 1570 British men examined in 2010–2012, aged 71–92 years. Sociodemographic and cardiometabolic factors were compared between participants defined as having TYM scores in the normal cognitive ageing, mild cognitive impairment (MCI) and severe cognitive impairment (SCI) groups, defined as ≥46 (45 if ≥80 years of age), ≥33 and <33, respectively.ResultsAmong 1570 men, 636 (41%) were classified in the MCI and 133 (8%) in the SCI groups. Compared with participants in the normal cognitive ageing category, individuals with SCI were characterized primarily by lower socio‐economic position (odds ratio (OR) = 6.15, 95% confidence interval (CI) 4.00–9.46), slower average walking speed (OR = 3.36, 95% CI 2.21–5.10), mobility problems (OR = 4.61, 95% CI 3.04–6.97), poorer self‐reported overall health (OR = 2.63, 95% CI 1.79–3.87), obesity (OR = 2.59, 95% CI 1.72–3.91) and impaired lung function (OR = 2.25, 95% CI 1.47–3.45). A similar albeit slightly weaker pattern was observed for participants with MCI.ConclusionSociodemographic and lifestyle factors as well as adiposity measures, lung function and poor overall health are associated with cognitive impairments in late life. The correlates of cognitive abilities in the MCI and SCI groups, as defined by the TYM, resemble the risk profile for MCI and Alzheimer's disease outlined in current epidemiological models. © 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons, Ltd.

Care mapping in clinical neuroscience settings: Cognitive impairment and dependency

Person-centred care can improve the well-being of patients and is therefore a key driver in healthcare developments in the UK. The current study aims to investigate the complex relationship between cognitive impairment, dependency and well-being in people with a wide range of acquired brain and spinal injuries. Sixty-five participants, with varied acquired brain and spinal injuries, were selected by convenience sampling from six inpatient clinical neuroscience settings. Participants were observed using Dementia Care Mapping – Neurorehabilitation (DCM-NR) and categorised based on severity of cognitive impairment.A significant difference in the behaviours participants engaged in, their well-being and dependency was found between the severe cognitive impairment group and the mild, moderate or no cognitive impairment groups. Dependency and cognitive impairment accounted for 23.9% of the variance in well–ill-being scores and 17.2% of the variance in potential for positive engagement. The current study highlights the impact of severe cognitive impairment and dependency on the behaviours patients engaged in and their well-being. It also affirms the utility of DCM-NR in providing insights into patient experience. Consideration is given to developing DCM-NR as a process that may improve person-centred care in neuroscience settings.

Is mini-mental score examination scoring a new predictor of uncontrolled hypertension?

Essential hypertension is an important risk factor for target organ damage. The brain is among the target organs infrequently visited. The authors evaluated whether an abnormal Mini-Mental Score Examination (MMSE) score predicts uncontrolled hypertension even if office blood pressure is normal. Seventy-seven hypertensive patients were included. The cognitive function of each patient was assessed using MMSE and a customized brain magnetic resonance imaging study. Patients were classified into normal cognitive function group and mild, moderate, and severe cognitive impairment groups. A significance level of P=.05 was used. There was a higher percentage of uncontrolled BP in every cognitive impairment class. In patients older than 65 years, MMSE score had a sensitivity and specificity of 94% and 83%, respectively, in the prediction of uncontrolled hypertension. MMSE is a simple test to run in the clinic to predict whether patients have well-controlled blood pressure.

Potential of diffusion tensor MR imaging in the assessment of cognitive impairments in children with periventricular leukomalacia born preterm

PurposeTo investigate MR diffusion tensor imaging (DTI) and fiber tractography (FT) in the assessment of altered major white matter fibers correlated with cognitive functions in preterm infants with periventricular leukomalacia (PVL), to explore the neural foundation for PVL children's cognitive impairments. Materials and methodsForty six preterm infants (16±4.7 months) suffered from PVL and 16 age-matched normal controls were recruited. Developmental quotient (DQ) was recorded to evaluate PVL children's cognitive functions. According to the DQ scores, patients were divided into three groups: mild, moderate and severe cognitive impairment groups. DTI scan was performed. Fractional anisotropy (FA) values of major white matter fibers were measured and their correlation with cognitive levels was evaluated. ResultsCompared with the control group, the PVL group showed a significant mean FA reduction in bilateral corticospinal tract (CST), anterior/posterior limb of internal capsule (ICAL/ICPL), arcuate fasciculus (AF), corona radiate (CR), superior longitudinal fasciculus (SLF), splenium of corpus callosum (SCC) (p<0.05) and bilateral posterior thalamic radiation (PTR) (p<0.01). The FA values of left CST, bilateral AF, anterior cingulum (ACG), SLF, ICAL, ICPL, PTR, CR, genu of corpus callosum (GCC), SCC and middle cerebellar peduncle showed significant negative correlations with the cognitive levels. ConclusionsDTI can provide more information for understanding the pathophysiology of cognitive impairment in preterm infants with PVL.