Types Of Cognitive Impairment Research Articles

Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement: a post-hoc analysis

BackgroundBilateral regional brain oxygen saturation (rSO2) trends, reflecting intraoperative brain oxygen imbalance, could warn of brain dysfunction. Various types of cognitive impairment, such as memory decline, alterations in executive function or subjective complaints, have been described three months after surgery. Our aim was to explore the potential utility of rSO2 values as a warning sign for the development of different types of decline in postoperative psychological function.MethodsObservational post-hoc analysis of data for the patient sample (n = 125) of a previously conducted clinical trial in patients over the age of 65 years undergoing total knee replacement under spinal anesthesia. Demographic, hemodynamic and bilateral rSO2 intraoperative values were recorded. An absolute rSO2 value of <50% or a reduction of >20% or >25% below baseline were chosen as relevant cutoffs. Composite function test scores were created from baseline to three months for each patient and adjusted for the mean (SD) score changes for a control group (n = 55). Tests were used to assess visual-motor coordination and executive function (VM-EF) (Wechsler Digit Symbol-Coding and Visual Reproduction, Trail Making Test) and memory (Auditory Verbal Learning, Wechsler Memory Scale); scales were used to assess psychological symptoms.ResultsWe observed no differences in baseline rSO2 values; rSO2 decreased significantly in all patients during surgery (P < 0.0001). Seventy-five patients (60%) had no sign of cognitive decline or psychological symptoms. Twenty-one patients (16.8%) had memory decline, 3 (2.4%) had VM-EF decline, and 33 (26.4%) had psychological symptoms. Left and right rSO2 values were asymmetric in patients who had memory decline (mean [SD] left-right ratio of 95.03 [8.51] vs 101.29 [6.7] for patients with no changes, P = 0.0012). The mean right-left difference in rSO2 was also significant in these patients (-2.87% [4.73%], lower on the right, P = 0.0034).ConclusionsDetection of a trend to asymmetry in rSO2 values can warn of possible postoperative onset of memory decline. Psychological symptoms and memory decline were common three months after knee replacement in our patients over the age of 65 years.

Neuropsychological performance of methadone-maintained opiate users.

Methadone maintenance treatment (MMT) has been used to treat opiate dependence since the mid-1960s. Previous studies have investigated the effects of methadone on cognitive function however the findings have been inconsistent. Some report a complete absence of deficits while others report different types of cognitive impairment. Our research aimed to investigate the effects of MMT on cognitive function by comparing the performance of patients currently enrolled in MMT (n=32) with opiate-dependent subjects (n=17) and healthy control subjects (n=25) on a computerised neuropsychological test battery. Both the patients undertaking MMT and the opiate users showed less efficient interaction between visual searching and manually connecting digits and letters during the Switching of Attention Task than the healthy control subjects (F(2,64)=3.25, p=0.05), which indicates deficits in information processing. Nevertheless, the performance of the MMT group was similar to that of healthy control subjects in all other tasks, in contrast to the group of opiate users who performed poorly when compared to healthy control subjects during tests of attention (mean difference (MD)=2.8, 95% confidence interval (CI) (0.9-4.7), p=0.001) and executive function (MD=5.9, 95% CI (1.3-10.5), p=0.007). These findings suggest that cognitive function in patients undertaking MMT is improved compared to those dependent on illicit opiates.

Frequency of the apolipoprotein E ε4 allele in a memory clinic cohort in Beijing: a naturalistic descriptive study.

ObjectivesTo describe the distribution of apolipoprotein E (APOE) genotypes among an elderly Chinese patient population with memory complaints treated in a memory clinic in Beijing and to compare the ε4 allele frequency among individuals with subjective cognitive impairment (SCI), mild cognitive impairment (MCI) and Alzheimer's disease (AD).MethodsA total of 385 subjects with memory complaints participated in the study, including 216 patients with AD, 56 with MCI, 17 with SCI, and 96 with other types of cognitive impairment. A total of 75 healthy elderly control subjects were also recruited. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique was used to investigate the APOE genotypes.ResultsThe frequency of the ε4 allele was 19.6 percent for the entire sample of patients who had memory complaints. The APOE allele distribution differed between women and men (22.6% and 14.9%, respectively; p<0.05) in the individuals with memory complaints. Compared with the control group (7.3%), the prevalence of the APOE ε4 allele was significantly higher in the AD (23.6%) and MCI (21.4%) groups and was slightly increased in the SCI (14.7%) group.ConclusionsIn the memory clinic, we observed a higher prevalence of the APOE ε4 allele among Chinese AD and MCI patients. A similar trend was observed in patients with SCI. These findings suggest that nondemented APOE ε4 allele carriers with memory complaints may have a greater genetic risk for AD and should be monitored more closely.

Postoperative Cognitive Dysfunction

Older patients in particular are vulnerable to memory disturbances and other types of cognitive impairment after surgical operations. In one study, roughly 12% of patients over age 60 had postoperative cognitive dysfunction (POCD) three months after surgery. This is an important issue in perioperative care as extensive surgery on older patients becomes more common. Selective review of the literature. POCD is usually transient. It is diagnosed by comparing pre- and postoperative findings on psychometric tests. Its pathogenesis is multifactorial, with the immune response to surgery probably acting as a trigger. Factors that elevate the risk of POCD include old age, pre-existing cerebral, cardiac, and vascular disease, alcohol abuse, low educational level, and intra- and postoperative complications. The findings of multiple randomized controlled trials indicate that the method of anesthesia does not play a causal role for prolonged cognitive impairment. POCD is associated with poorer recovery and increased utilization of social financial assistance. It is also associated with higher mortality (hazard ratio 1.63, 95% confidence interval 1.11-2.38). Persistent POCD enters into the differential diagnosis of dementia. POCD can markedly impair postoperative recovery. The findings of pertinent studies performed to date are difficult to generalize because of heterogeneous patient groups and different measuring techniques and study designs. Further investigation is needed to determine which test instruments are best for clinical use and which preventive strategies might lessen the incidence of POCD.

Functional MRI Signal Fluctuations: A Preclinical Biomarker for Cognitive Impairment in Type 2 Diabetes?

Type 2 diabetes mellitus (T2DM) is associated with macrovascular and microvascular complications as well as an increased risk for cognitive impairment (CI), ranging from mild memory impairment to fully developed dementia (1). Both vascular dementia (VD) and Alzheimer disease (AD) dementia are increased in patients with T2DM. However, it is not clear if T2DM directly causes CI and dementia or if the two disorders share a common pathophysiological process (2). Insulin resistance, hyperglycemia, and hypoglycemia have all been implicated as risk factors for CI in T2DM (3). However, their relative importance remains uncertain. The possibility that altered brain insulin action plays a role is consistent with human data showing that AD is associated with decreased insulin receptor expression in the brain (4), impaired insulin signaling (5), and decreased insulin levels in the cerebrospinal fluid (CSF) (6). Furthermore, insulin delivery directly into the hippocampus enhances spatial memory in nondiabetic rats, whereas this response to intrahippocampal insulin is impaired in diet-induced obese rats (7). In small clinical trials, intranasal insulin delivery appears to improve memory function in patients with CI and AD (8). Functional MRI, based on the blood oxygenation level–dependent (BOLD) contrast mechanism, has become an important tool to investigate the brain’s neurophysiologic response to specific stimuli or cognitive tasks. In contrast, resting-state functional MRI (rs-fMRI) measures spontaneous low-frequency oscillations in the BOLD …

Neuroimaging of Epilepsy: Lesions, Networks, Oscillations

While analysis and interpretation of structural epileptogenic lesion is an essential task for the neuroradiologist in clinical practice, a substantial body of epilepsy research has shown that focal lesions influence brain areas beyond the epileptogenic lesion, across ensembles of functionally and anatomically connected brain areas. In this review article, we aim to provide an overview about altered network compositions in epilepsy, as measured with current advanced neuroimaging techniques to characterize the initiation and spread of epileptic activity in the brain with multimodal noninvasive imaging techniques. We focus on resting-state functional magnetic resonance imaging (MRI) and simultaneous electroencephalography/fMRI, and oppose the findings in idiopathic generalized versus focal epilepsies. These data indicate that circumscribed epileptogenic lesions can have extended effects on many brain systems. Although epileptic seizures may involve various brain areas, seizure activity does not spread diffusely throughout the brain but propagates along specific anatomic pathways that characterize the underlying epilepsy syndrome. Such a functionally oriented approach may help to better understand a range of clinical phenomena such as the type of cognitive impairment, the development of pharmacoresistance, the propagation pathways of seizures, or the success of epilepsy surgery.

Near Vision Impairment Is Associated With Cognitive Impairment in Type 2 Diabetes.

The objective of this study was to assess the relationship between vision and cognitive impairment in patients with type 2 diabetes mellitus (DM) who are at risk of both conditions. This was a cross-sectional study. Persons with type 2 DM underwent a comprehensive clinical examination. Distance and near vision tests were performed, and presence and severity of diabetic retinopathy and diabetic macular edema, indicators of DM control such as fasting plasma glucose and glycosylated hemoglobin, and anthropometric measures were assessed using standardized protocols. Depression status and level of physical activity were measured using validated questionnaires. Adjusted logistic regression models were used to examine the association between near and distance vision impairment and cognitive impairment tested with a 6-item cognitive impairment test. Participants (n = 501) were aged 66 ± 11 (mean ± SD) years, and their mean duration of DM was 14 ± 10 years. In adjusted models, near (P = 0.016) but not distance (P = 0.984) vision impairment was associated with cognitive impairment. Persons with near vision impairment were almost 4 times more likely to have cognitive impairment (odds ratio 3.90; 95% confidence interval, 1.31-12.56; P = 0.023), after adjusting for age, sex, and other covariables. Our findings suggest common risk factors and pathways may exist between near vision impairment and cognitive dysfunction in patients with type 2 DM. Future studies need to further assess this link.

PI3K/Akt Signal Pathway Involved in the Cognitive Impairment Caused by Chronic Cerebral Hypoperfusion in Rats

Chronic cerebral hypoperfusion (CCH) is a common pathophysiological state that usually occurs in conditions such as vascular dementia and Alzheimer's disease, both of which are characterized by cognitive impairment. In previous studies we found that learning capacity and memory were gradually impaired with CCH, which altered the expression of synaptophysin, microtubule associated protein-2, growth associated protein-43, brain-derived neurotrophic factor, nerve growth factor, N-methyl-D-aspartate receptor subunit 1, cAMP response element-binding protein and tau hyperphosphorylation in the hippocampus. However, the molecular basis of cognitive impairment in CCH remains obscure. Here we explore the hypothesis that the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signal pathway is involved in this type of cognitive impairment. In order to determine if the expression of PI3K, Akt and phosphorylated Akt (p-Akt) proteins are altered at different stages of CCH with differing levels of cognitive impairment. we performed permanent, bilateral occlusion of the common carotid arteries (2-VO) to induce CCH. Adult male SD rats were randomly divided into sham-operated group, 2-VO 1 week group, 2-VO 4 weeks group and 2-VO 8 weeks group. Behavior tests were utilized to assess cognitive abilities, while western blots were utilized to evaluate protein expression. Rats in the 2-VO groups spent less time exploring novel objects than those in the sham-operated group, and the discrimination ratio of the 2-VO 8 weeks group and the sham-operated group were higher than chance (0.50). Escape latencies in the Morris water maze task in the 2-VO 1 week group were longer than those in the sham-operated group on day 4 and day 5, while escape latencies in the 2-VO 4 weeks group were longer than those in the sham-operated group from day 3 to day 5. Escape latencies in 2-VO 8 weeks group were longer than those in the sham-operated group from day 2 to day 5. NE (northeast) square swimming times in the 2-VO 1 week group, 2-VO 4 weeks group and 2-VO 8 weeks group were shorter than that in the sham-operated group. Western blotting showed that the PI3K expression in the 2-VO 1 week group was lower than that in sham-operated group, while p-Akt expression in the 2-VO 8 weeks group was higher than that in the sham-operated group. There was a linear relationship between the PI3K expression and the discrimination ratio, as well as a linear relationship between the PI3K and NE square swimming time. Thus, we propose that the PI3K/Akt signal pathway is an important cell pathway that is associated with the cognitive impairment following CCH.

Grand Total EEG as a Predictive Biomarker for Cognitive Impairment Severity in Cerebral Infarcts of Chinese

Cerebral infarct (CI) is a common disease of older adults, which increases the risk for cognitive impairment or dementia. CI-associated mild cognitive impairment is a potential prodromal stage of serious cognitive impairment. The grand total EEG (GTE) score is a rating scale for clinical electroencephalography (EEG) analyses, which is useful in the evaluation of different types of cognitive impairment. Sixty-five patients with CI underwent neuropsychological testing and resting state EEG. Spearman rank correlation analysis was used to investigate the relationship between a short version of the GTE score and severity of cognitive impairment in CI. Significant correlations with deteriorating cognition (combined Montreal Cognitive Assessment/clock drawing test) were found for the overall short GTE score (Spearman rank correlation, p = -0.61, r = -0.88491, P = 0.009) and for the subscore "Frequency of Rhythmic Background Activity" (p = -0.63, r = -0.92559, P = 0.007). In conclusion, the GTE short score and Frequency of Rhythmic Background Activity were increased with the deteriorating cognitive impairment in patients with CI.

Hypertensive disease in the elderly: Predictors of clinical evolution in a follow-up study

and sedentariness were associated with low self-rated memory (B=−0.35 (0.06), P<0.001; B=−0.16 (0.04), P<0.001). Slow gait was associated with poorer attention and processing speed (B=−0.25 (0.05), P<0.001; B=−0.18 (0.06), P<0.01) while both slow gait and poor grip were associated with poor executive function (B=−0.12 (0.05), P<0.001; B=−0.15 (0.05), P<0.01). Unintentional weight loss did not predict performance in any domain. Conclusion.–This paperhighlights thepotentially important clinical message that it not just whether, but how, someone is defined as frail which may determine their risk and type of cognitive impairment.

Serum levels of 25-hydroxyvitamin D are associated with cognitive impairment in type 2 diabetic adults

Hypovitaminosis D is highly prevalent in type 2 diabetes. The aim of this study is to determine the serum levels of 25-hydroxyvitamin D [25(OH)D] in type 2 diabetic patients with and without mild cognitive impairment (MCI), and examine the relationship of 25(OH)D and MCI with other clinical factors. One hundred and sixty-five diabetic patients were enrolled in this study. Among whom, 95 patients were considered as MCI [Montreal Cognitive Assessment score (MoCA) < 26] and the other 70 as no MCI (MoCA ≥ 26). Subjects were assessed clinically. Diabetic patients with MCI had a longer duration of DM, fewer years of education, elevated fasting blood glucose (FBG), resistant index (RI) of carotid, and lower levels of 25(OH)D {[17.35 (13.02-25.92) vs 28.00 (19.67-34.30)] ng/ml, P < 0.001}. The MoCA score was positively correlated with log10[25(OH)D], education year, and inversely correlated with duration of DM, history of hypertension, intima-media thickness (IMT), FBG, max-RI, and min-RI. Log10[25(OH)D] was positively correlated with MoCA score, and inversely correlated with IMT, in multivariate regression analysis adjusted for age, sex, and education year, 25(OH)D (β = 0.210, P = 0.003), history of hypertension (β = -0.191, P = 0.007), IMT (β = -0.194, P = 0.007), and FBG (β = -0.157, P = 0.026) independently predicted MoCA score. In conclusion, our results suggest that levels of serum 25(OH)D are inversely associated with the cognitive impairment in diabetic patients. Vitamin D may be a potential protective factor for cognitive impairment in patients with type 2 diabetes.

Neurocognitive Decline Unrelated to Mild Cognitive Impairment in Type 1 Diabetes

Patients with type 1 diabetes (T1D) experienced a gradual decline in certain cognitive functions, but the decline was not comparable to mild cognitive impairment, which is a precursor of dementia. The decline in brain volume loss was associated with higher baseline systolic blood pressure, while a decline in executive function was associated with baseline elevated HbA1C in patients with T1D, according to the 4-year follow-up data.

Possible synergistic effect of direct angiotensin II type 2 receptor stimulation by compound 21 with memantine on cognitive impairment in type 2 diabetic mouse

Possible synergistic effect of direct angiotensin II type 2 receptor stimulation by compound 21 with memantine on cognitive impairment in type 2 diabetic mouse

Research on Cognitive Impairment in Community and Home Settings

Mounting evidence demonstrates the significant impact of cognitive impairment on the lives of older adult patients and their caregivers. In addition, cognitive impairment presents challenging conditions for healthcare providers who are frequently unprepared to manage the care of these patients. These developments have spawned a wide range of research to more effectively identify and diagnose individuals with cognitive impairments, to develop better strategies to differentiate the types of cognitive impairment, and more accurately estimate the incidence and prevalence of the different types of impairments within different treatment settings. The 4 articles presented in this article represent a small sampling of recent research on these topics. Each article possesses methodological and other limitations that limit the generalizability of their findings. Nonetheless, there are important lessons to be learned from each. The first article examines the effectiveness of using a single-item measure to screen for delirium, one form of cognitive impairment. The second article presents the findings of a systematic review of research articles that estimate the prevalence of missed and delayed diagnoses of dementia. Efforts to understand factors that contribute to missed or delayed diagnoses may result in more robust strategies to improve timely diagnoses and effective interventions. The third article attempts to differentiate the prevalence of cognitive impairment that does not progress to a diagnosis of dementia. The findings suggest that, contrary to conventional thought, not every patient with cognitive impairment will ultimately have dementia. The final article illustrates the difficulties of identifying community-dwelling older adults with dementia. Once identified, the authors determined that patients and their families have wide range of unmet needs that may be addressed with better preparation of healthcare providers. Future research may produce more robust evidence on these important topics.

Prevalence and Comorbidity of Nocturnal Wandering in the Us Adult General Population

As noted by Ohayon et al., nocturnal wandering (NW) is not synonymous with sleepwalking. NW may also refer to wandering during the night due to epilepsy. Alcohol intoxication can also result in drunken behavior while awake, but this type of cognitive impairment may be undistinguishable from other forms of NW. Dementia and CNS drug effects can also result in NW.

アルツハイマー病と血管性認知症高齢者の食行動の比較に関する調査報告：第一報―食行動変化について―

In elderly patients with dementia, it is known that a loss of independence in eating can cause malnutrition, dehydration, a decrease in food consumption and the immune function and further worsening of the cognitive function, with an increased risk of pneumonia and a shortened life expectancy. The purpose of this study was to investigate the occurrence of a disturbed eating behavior in elderly patients with Alzheimer's disease (AD) and vascular dementia (VaD), who together comprise the majority of elderly patients with dementia. A total of 233 patients (150 AD patients and 83 VaD patients) who were residents of institutions or group homes were enrolled. The patients underwent an assessment of eating behavior, a cognitive assessment, a neurological examination and measurement of the vital signs. Additionally, statistical analyses were performed to compare eating behavior between the patients with AD and those with VaD at varying severity of dementia. A disturbed eating behavior was observed significantly more frequently as the severity of dementia increased. The prevalence of difficulty in rinsing/gargling and dysphagia increased with the severity of dementia. There were differences in the frequency of disturbed eating behavior between the AD and VaD patients. Among the patients with mild dementia, the VaD patients exhibited a higher incidence of a disturbed eating behavior than the AD patients. On the other hand, some behaviors prominent in the patients with severe dementia were related to various types of cognitive impairment in the AD patients, namely difficulty in beginning a meal, difficulty in maintaining attention while eating and difficulty in performing the specific motor skills necessary to open food packages. Marked individual differences were observed in the mild VaD patients, with a high frequency of disturbed eating behavior and dysphagia related to symptoms of neurological deficits. No correlations were found with the severity of dementia. Both AD and VaD are types of dementia; however, the frequency of a disturbed eating behavior differs greatly between these populations. It is necessary to focus on differences in these parameters and also the causes of dementia in order to develop effective care techniques for patients with dementia.

Functional capacity of elderly people attending the Family Health Program at Viveiros, Feira de Santana, Bahia

As people grow older, their functional losses become more and more evident. The elderly will progressively stop performing basic activities of life, thereby decreasing his/her functional capacity - measured in terms of his/her independence and ability to perform certain daily activities. Objective: To assess the functional capacity of elderly people attending the Family Health Program (“Programa Saúde da Família”) in the neighborhood of Viveiros, Feira de Santana, Bahia. Method: This study is a cross-sectional research with a quantitative approach. The sample consisted of 34 male and female patients, aged 75. We conducted home visits to each of these elderly persons in order to apply three types of test: the Barthel Index, the Lawton Index and the Mini Mental State Examination. Results: The results show that 54.5% of these elders were found to be independent according to the Barthel Index, 51.5% were totally dependent according to the Lowton Index and 87.9% have some type of cognitive impairment according to the Mini Mental State Examination. Conclusion: Professionals working in the Family Health Program have to pay attention to the health status of the elderly, developing their care plan in accordance with the elderly’s actual needs. We hope that the interest of other researchers about the proposed topic will be raised, in order to increase the availability of research (currently scarce) in this area of knowledge, so that the elderly will receive more adequate attention and counseling, by expanding the range of services and programs available to them.

Neurocognitive function in bipolar disorder

Cognitive deficits have been documented in patients with bipolar disorder. Further, it has been suggested that the degree and type of cognitive impairment differ between bipolar I and bipolar II disorder, but data is conflicting and remains inconclusive. This study aimed to clarify the suggested differences in cognitive impairment between patients with bipolar I and II disorder in a relatively large, clinically stable sample while controlling for potential confounders. 67 patients with bipolar I disorder, 43 with bipolar II disorder, and 86 randomly selected population-based healthy controls were compared. A number of neuropsychological tests were administered, assessing verbal and visual memory and executive functions. Patients were in a stable phase during testing. Patients with bipolar type I and type II were cognitively impaired compared to healthy controls, but there were no statistically significant differences between the two subtypes. The strongest predictor of cognitive impairment within the patient group was current antipsychotic treatment. The present study suggests that the type and degree of cognitive dysfunction is similar in bipolar I and II patients. Notably, treatment with antipsychotics - but not a history of psychosis - was associated with more severe cognitive impairment. Given that patients with bipolar I disorder are more likely to be on antipsychotic drugs, this might explain why some previous studies have found that patients with type I bipolar disorder are more cognitively impaired than those with type II.

English

Vascular cognitive impairment refers to the risk factors derived from blood vessels caused by a variety of levels and types of cognitive impairment, such as vascular mild cognitive impairment, vascular dementia and mixed dementia. Using acupuncture for mild cognitive impairment leukoaraiosis has impacts on the functional magnetic resonance. To know the neurotransmitter changes before and after acupuncture intervention in mild cognitive impairment with the functional magnetic resonance brain, laboratory for music and communication in infancy (LAMCI) cases (23), and 13 normal subjects (control group) cases were observed. Acupuncture treatment and the natural process group were observed for 3 months, respectively. Neuropsychological evaluation and magnetic resonance spectroscopy check were executed at the beginning and end of each day. Neuropsychological assessment includes mini-mental state examination (MMSE) and montreal cognitive assessment (MoCA), magnetic resonance imaging (MRI), spectroscopy N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, and myoinositol (MI)/Cr. The results showed that acupuncture can be used as an effective means of intervention for mild cognitive impairment leukoaraiosis, which can reduce activated brain regions in order to raise the efficiency of the task when stimulation is processed. &nbsp; Key words:&nbsp;Acupuncture, leukoaraiosis, mild cognitive impairment, functional magnetic resonance, magnetic resonance spectroscopy.

O2‐05‐05: PPAR‐gamma activation with AT1 receptor blockade prevents blood‐brain barrier disruption and cognitive impairment in type 2 diabetic mellitus mice

O2‐05‐05: PPAR‐gamma activation with AT1 receptor blockade prevents blood‐brain barrier disruption and cognitive impairment in type 2 diabetic mellitus mice