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INTRODUCTION: Neuropsychiatric symptoms may impact prognosis in individuals with mild cognitive impairment (MCI); however, data on frequency of psychotic symptoms are sparse. METHODS: We searched MEDLINE, EMBASE, PsychoINFO from inception to June 2023. We included studies reporting patients with MCI prevalence of (delusions and/or hallucinations. Random effects model were performed to estimate the prevalence, and subgroup and meta-regression analyses were performed to explore heterogeneity. RESULTS: Of 3145 records identified, 36 studies were included, enrolling 20,426 patients. Overall prevalence of hallucinations was 1.78â¯% (95â¯% CI, 1.17 - 2.71) and delusions 3.84â¯% (95â¯% CI, 2.71 - 5.42), both with significant heterogeneity (/2 = 90â¯%). Prevalence of hallucinations and delusions were lower when measured by NPI scales and in population-based samples. DISCUSSION: Delusions and hallucinations occur in MCI patients at low rates. Prevalence can be partially explained by the assessment method, sample source and study heterogeneity.
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Disfunção Cognitiva , Alucinações , Transtornos Psicóticos , Humanos , Disfunção Cognitiva/complicações , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Delusões/complicações , Delusões/epidemiologia , Delusões/psicologia , Alucinações/complicações , Alucinações/epidemiologia , Alucinações/psicologia , Prevalência , Transtornos Psicóticos/complicações , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologiaRESUMO
INTRODUCTION: Cognitive impairment associated with borderline personality disorder (BPD) has been consistently demonstrated. However, a specific neuropsychological profile has not yet been established for this disorder, maybe due to the heterogeneity of BPD. The aim of this work is the search for distinct neuropsychological subtypes among patients with BPD and for the association of neuropsychological subgroups with specific clinical characteristics. METHODOLOGY: One hundred fifteen patients with BPD diagnosis received an extensive neuropsychological evaluation assessing attentional, memory and executive functions indexes. For subtyping strategies, a cluster analysis of neuropsychological BPD distribution was performed. Central clinical dimensions of BPD were measured and analysed in relation with the obtained neuropsychological clusters. RESULTS: Two clusters were found: Cluster 1 showed a significantly lower score on the working memory index, and Cluster 2 had significantly worse overall executive performance, response inhibition and planning abilities. Patients in the neurocognitive Cluster 2 showed significantly higher clinical deficits of attention as measured with subscales of the CAARS attention deficit hyperactivity disorder (ADHD) index (F = 2.549, p < 0.005, d = 11.49). CONCLUSIONS: Two neuropsychological clusters of patients were found in the BPD sample: Cluster 1 patients showed greater impairment in working memory, while Cluster 2 patients had greater deficits of executive functioning, particularly for response inhibition and planning. In addition, BPD patients with greater executive deficits presented greater levels of ADHD clinical features. These findings might also facilitate earlier diagnosis of severe BPD patient profiles and to establish more personalized treatment based on neurocognitive stimulation.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno da Personalidade Borderline , Função Executiva , Testes Neuropsicológicos , Humanos , Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/complicações , Transtorno da Personalidade Borderline/diagnóstico , Feminino , Masculino , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Testes Neuropsicológicos/estatística & dados numéricos , Adulto , Análise por Conglomerados , Memória de Curto Prazo , Adulto Jovem , Disfunção Cognitiva/psicologia , Disfunção Cognitiva/complicações , AtençãoRESUMO
Considering the frequency and severity of olfactory disorders associated with SARS-CoV-2 infection, attention to the olfactory loss has expanded. The aim of our study was to assess of smell disturbances 6 months after COVID-19. The study population consisted of 2 groups: 196 Post-COVID-19 patients who were hospitalized because of COVID-19, control sample-130 patients without reported smell disorders from general population-Bialystok PLUS study. People from both groups were asked to participate in the Sniffin Sticks Test (half year after the disease). Sniffin Sticks Test consisted of 12 standardized smell samples. The participant's test score was counted based on correct scent recognition. Middle/older age was related with lower likelihood of olfaction recovery. The biggest differences in recognition of particular fragrances were observed for: orange and lemon, lemon and coffee (p.adj < 0.001). Patients had the greatest problem in assessing smell of lemon. The comparison of scores between Delta, Omicron, Wild Type, Wild Type Alpha waves showed statistically significant difference between Delta and Wild Type waves (p = 0.006). Duration of the disease (r = 0.218), age (r = -0.253), IL-6 (r = -0.281) showed significant negative correlations with the score. Statistically significant variables in the case of smell disorders were Omicron wave (CI = 0.045-0.902; P = 0.046) and Wild Type wave (CI = 0.135-0.716; P = 0.007) compared to Delta wave reference. Moreover, patients with PLT count below 150 000/µl had greater olfactory disorders than those with PLT count over 150 000/µl. There are: smell differences between post-COVID-19 patients and healthy population; statistically significant difference between Delta and Wild Type waves in Post-COVID-19 group in score of the Sniffin Sticks Test. Smell disturbances depend on the age, cognitive impairments, clinical characteristics of the COVID-19 disease and sex of the patient.
Assuntos
Anosmia , COVID-19 , SARS-CoV-2 , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/patologia , Anosmia/epidemiologia , Anosmia/patologia , Anosmia/virologia , Gravidade do Paciente , SARS-CoV-2/classificação , SARS-CoV-2/fisiologia , Fatores de Tempo , Fatores Etários , Disfunção Cognitiva/complicações , Polônia/epidemiologiaRESUMO
Objective and objectives: Patients with cognitive disorders such as Alzheimer's disease (AD) and mild cognitive impairment (MCI) frequently exhibit depressive symptoms. Depressive symptoms can be evaluated with various measures and questionnaires. The geriatric depression scale (GDS) is a scale that can be used to measure symptoms in geriatric age. Many questionnaires sum up symptom scales. However, core symptoms of depression in these patients and connections between these symptoms have not been fully explored yet. Thus, the objectives of this study were (1) to determine core symptoms of two cognitive disorders, Alzheimer's disease and mild cognitive impairment, and (2) to investigate the network structure of depressive symptomatology in individuals with cognitive impairment in comparison with those with Alzheimer's disease. Materials and Methods: This study encompassed 5354 patients with cognitive impairments such as Alzheimer's disease (n 1889) and mild cognitive impairment (n = 3464). The geriatric depression scale, a self-administered questionnaire, was employed to assess depressive symptomatology. Using exploratory graph analysis (EGA), a network analysis was conducted, and the network structure was evaluated through regularized partial correlation models. To determine the centrality of depressive symptoms within each cohort, network parameters such as strength, betweenness, and closeness were examined. Additionally, to explore differences in the network structure between Alzheimer's disease and mild cognitive impairment groups, a network comparison test was performed. Results: In the analysis of centrality indices, "worthlessness" was identified as the most central symptom in the geriatric depression scale among patients with Alzheimer's disease, whereas "emptiness" was found to be the most central symptom in patients with mild cognitive impairment. Despite these differences in central symptoms, the comparative analysis showed no statistical difference in the overall network structure between Alzheimer's disease and mild cognitive impairment groups. Conclusions: Findings of this study could contribute to a better understanding of the manifestation of depressive symptoms in patients with cognitive impairment. These results are expected to aid in identifying and prioritizing core symptoms in these patients. Further research should be conducted to explore potential interventions tailored to these core symptoms in patients with Alzheimer's disease and mild cognitive impairment. Establishing core symptoms in those groups might have clinical importance in that appropriate treatment for neuropsychiatric symptoms in patients with cognitive impairment could help preclude progression to further impairment.
Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Depressão , Humanos , Idoso , Feminino , Masculino , Disfunção Cognitiva/psicologia , Disfunção Cognitiva/complicações , Depressão/psicologia , Idoso de 80 Anos ou mais , Doença de Alzheimer/psicologia , Doença de Alzheimer/complicações , Inquéritos e Questionários , Escalas de Graduação PsiquiátricaRESUMO
BACKGROUND: Late-Life Depression (LLD) is a prevalent mental health disorder that is often accompanied by cognitive impairments. The objective of this study is to investigate the influence of coexisting Generalized Anxiety Disorder (GAD) on both subjective and objective cognitive abilities in untreated LLD individuals. METHODS: A total of 77 participants aged 60 years and above were recruited for this study, comprising 31 individuals with Major Depressive Disorder (LLD group), 46 with MDD and coexisting Generalized Anxiety Disorder (LLDA group), and 54 healthy controls (HC). Prior to the study, all patients had abstained from psychotropic medication for a minimum of two weeks. Comprehensive neuropsychological assessments were administered to all participants. RESULTS: The LLDA group exhibited substantial disparities in memory, attention, processing speed,executive function,overall cognitive functioning, and subjective cognitive functioning when compared to the HC group. The LLD group displayed deficits in memory, SCWT-W in attention, SCWT-C in processing speed,overall cognitive functioning, and subjective cognitive functioning in comparison to the healthy controls. Although the LLD group achieved lower average scores in executive function, TMTA in processing speed, and DSST in attention than the HC group, no significant distinctions were identified between these groups in these domains. Linear regression analysis unveiled that anxiety symptoms had a significant impact on subjective cognitive deficits among MDD patients, but exhibited a milder influence on objective cognitive performance. After adjusting for the severity of depression, anxiety symptoms were found to affect TMTA in processing speed and subjective cognitive functioning in LLD patients. CONCLUSION: Late-Life Depression (LLD) exhibits pervasive cognitive impairments, particularly in individuals with generalized anxiety disorder, presenting a crucial target for future therapeutic interventions. Among elderly individuals with depression, anxiety symptoms significantly impact subjective cognitive functioning, suggesting its potential utility in distinguishing between depression-associated cognitive decline and pre-dementia conditions.
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Transtornos de Ansiedade , Disfunção Cognitiva , Transtorno Depressivo Maior , Função Executiva , Testes Neuropsicológicos , Humanos , Masculino , Feminino , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/epidemiologia , Idoso , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/complicações , Pessoa de Meia-Idade , Disfunção Cognitiva/psicologia , Disfunção Cognitiva/complicações , Disfunção Cognitiva/epidemiologia , Função Executiva/fisiologia , Comorbidade , Cognição , AtençãoRESUMO
OBJECTIVES: The sarcopenia (SI) index, defined as the serum creatinine to cystatin C ratio, is considered a predictor of poor muscle health and malnutrition, which is related to major adverse cardiovascular events. However, the effect of the SI index on cognitive function in stroke patients remains unknown. In this study, we aimed to examine the association between the SI and longitudinal cognitive impairment in patients with acute ischemic stroke or transient ischemic attack. RESEARCH DESIGN AND METHODS: Participants who met the inclusion criteria in this national, multicenter, prospective cohort study were enrolled from the Impairment of Cognition and Sleep (ICONS) study of the China National Stroke Registry-3 (CNSR-3). They were categorized into four groups according to the quartile of the SI index. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) scale. Multivariable-adjusted logistic regression models were performed to evaluate the association between the SI index and post-stroke cognitive impairment (PSCI) at the 3-month follow-up. Moreover, discrimination tests were used to evaluate the incremental predictive value of the SI index beyond the potential risk factors. Furthermore, we performed subgroup analyses to test interactions. RESULTS: Among the enrolled participants, the lower the SI index was, the worse the cognitive performance. At the 3-month follow-up, participants in the lowest SI quartile group exhibited a 42% increase in the risk of cognitive impairment relative to the highest quartile group [OR 0.58 (95% CI 0.37-0.90)]. Moreover, after applying the discrimination test, adding the SI index into the potential risk factors resulted in a slight improvement in predicting the risk of cognitive impairment [NRI 14% (P = 0.01)]. CONCLUSION: This study demonstrated that a lower sarcopenia index was positively associated with a higher prevalence of PSCI. Monitoring the SI index in stroke patients and early identification and treatment of individuals with low SI level may be helpful to reduce the risk of cognitive impairment.
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Disfunção Cognitiva , Ataque Isquêmico Transitório , AVC Isquêmico , Sarcopenia , Humanos , Sarcopenia/epidemiologia , Sarcopenia/complicações , Masculino , Feminino , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/complicações , Pessoa de Meia-Idade , Idoso , Ataque Isquêmico Transitório/complicações , Estudos Prospectivos , AVC Isquêmico/complicações , China/epidemiologia , Fatores de Risco , Creatinina/sangue , Cistatina C/sangue , Estudos de CoortesRESUMO
Alzheimer's disease (AD) and post-stroke cognitive impairment (PSCI) are the leading causes of progressive dementia related to neurodegenerative and cerebrovascular injuries in elderly populations. Despite decades of research, patients with these conditions still lack minimally invasive, low-cost, and effective diagnostic and treatment methods. MicroRNAs (miRNAs) play a vital role in AD and PSCI pathology. As they are easily obtained from patients, miRNAs are promising candidates for the diagnosis and treatment of these two disorders. In this study, we performed complete sequencing analysis of miRNAs from 24 participants, split evenly into the PSCI, post-stroke non-cognitive impairment (PSNCI), AD, and normal control (NC) groups. To screen for differentially expressed miRNAs (DE-miRNAs) in patients, we predicted their target genes using bioinformatics analysis. Our analyses identified miRNAs that can distinguish between the investigated disorders; several of them were novel and never previously reported. Their target genes play key roles in multiple signaling pathways that have potential to be modified as a clinical treatment. In conclusion, our study demonstrates the potential of miRNAs and their key target genes in disease management. Further in-depth investigations with larger sample sizes will contribute to the development of precise treatments for AD and PSCI.
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Doença de Alzheimer , Transtornos Cognitivos , Disfunção Cognitiva , MicroRNAs , Acidente Vascular Cerebral , Humanos , Idoso , MicroRNAs/genética , Transtornos Cognitivos/etiologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/genética , Disfunção Cognitiva/complicações , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/genética , Doença de Alzheimer/complicações , Biomarcadores , Acidente Vascular Cerebral/complicaçõesRESUMO
<br><b>Introduction:</b> The early detection and diagnosis of dementia are of key importance in treatment, slowing disease progression, or suppressing symptoms. The possible role of changes in the sense of smell is considered with regard to potential markers for early detection of Alzheimer's disease (AD).</br> <br><b>Materials and methods:</b> A literature search was conducted using the electronic databases PubMed, Scopus, and Web of Science between May 30, 2022 and August 2, 2022. The term "dementia" was searched with keyword combinations related to olfaction.</br> <br><b>Results:</b> A total of 1,288 records were identified through the database search. Of these articles, 49 were ultimately included in the analysis. The results showed the potential role of changes in the sense of smell as potential biomarkers for early detection of AD. Multiple studies have shown that olfactory impairment may be observed in patients with AD, PD, MCI, or other types of dementia. Even though smell tests are able to detect olfactory loss caused by neurodegenerative diseases, they cannot reliably distinguish between certain diseases.</br> <br><b>Conclusions:</b> In individuals with cognitive impairment or neurodegenerative diseases, olfactory assessment has repeatedly been reported to be used for early diagnosis, but not for differential diagnosis.</br>.
Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Transtornos do Olfato , Humanos , Disfunção Cognitiva/complicações , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/etiologia , OlfatoRESUMO
INTRODUCTION: Stroke survivors develop cognitive impairment, which significantly impacts their quality of life, their families, and the community as a whole but not given attention. This study aims to determine the incidence and predictors of post-stroke cognitive impairment (PSCI) among adult stroke patients admitted to a tertiary hospital in Dodoma, Tanzania. METHODOLOGY: A prospective cohort study was conducted at tertiary hospitals in the Dodoma region, central Tanzania. A sample size of 158 participants with the first stroke confirmed by CT/MRI brain aged ≥ 18 years met the criteria. At baseline, social-demographic, cardiovascular risks and stroke characteristics were acquired, and then at 30 days, participants were evaluated for cognitive functioning using Montreal Cognitive Assessment (MoCA). Key confounders for cognitive impairment, such as depression and apathy, were evaluated using the Personal Health Questionnaire (PHQ-9) and Apathy Evaluation Scale (AES), respectively. Descriptive statistics were used to summarise data; continuous data were reported as Mean (SD) or Median (IQR), and categorical data were summarised using proportions and frequencies. Univariate and multivariable logistic regression analysis was used to determine predictors of PSCI. RESULTS: The median age of the 158 participants was 58.7 years; 57.6% of them were female, and 80.4% of them met the required criteria for post-stroke cognitive impairment. After multivariable logistic regression, left hemisphere stroke (AOR: 5.798, CI: 1.030-32.623, p = 0.046), a unit cm3 increase in infarct volume (AOR: 1.064, 95% CI: 1.018-1.113, p = 0.007), and apathy symptoms (AOR: 12.259, CI: 1.112-89.173, p = 0.041) had a significant association with PSCI. CONCLUSION: The study revealed a significant prevalence of PSCI; early intervention targeting stroke survivors at risk may improve their outcomes. Future research in the field will serve to dictate policies and initiatives.
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Transtornos Cognitivos , Disfunção Cognitiva , Acidente Vascular Cerebral , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Centros de Atenção Terciária , Estudos Prospectivos , Incidência , Qualidade de Vida , Tanzânia/epidemiologia , Transtornos Cognitivos/diagnóstico , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/complicaçõesRESUMO
INTRODUCTION: Major Depressive Disorder (MDD) is a mental health issue that significantly affects patients' quality of life and functioning. Despite available treatments, many patients continue to suffer due to incomplete symptom resolution and side effects. AREAS COVERED: This manuscript examines Vortioxetine's role in Major Depressive Disorder (MDD) treatment, highlighting its potential to reshape therapeutic strategies due to its unique Multimodal action and proven broad-spectrum efficacy in multiple depressive domains. A detailed examination of Vortioxetine's pharmacological aspects, including indications, dosage, pharmacodynamics, and pharmacokinetics, is provided, emphasizing its safety and effectiveness. The discussion extends to Vortioxetine's role in acute-phase treatment and maintenance of MDD and its profound impact on specialized depression domains. EXPERT OPINION: Vortioxetine is distinguished for its novel multimodal serotonin modulation mechanism, showcasing significant promise as an innovative treatment for MDD. Its efficacy, which is dose-dependent, along with a commendable tolerability profile, positions it as a potential leading option for initial treatment strategies. The discourse on dosage titration, particularly the strategy of initiating treatment at lower doses followed by gradual escalation, underscores the approach toward minimizing initial adverse effects while optimizing therapeutic outcomes, aligning with the principles of personalized medicine in psychiatric care.
Assuntos
Transtorno Depressivo Maior , Vortioxetina , Antidepressivos/administração & dosagem , Antidepressivos/uso terapêutico , Ansiedade/complicações , Disfunção Cognitiva/complicações , Disfunção Cognitiva/tratamento farmacológico , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Emoções/efeitos dos fármacos , Escitalopram/administração & dosagem , Escitalopram/uso terapêutico , Síndrome de COVID-19 Pós-Aguda/complicações , Medicina de Precisão , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Serotonina/metabolismo , Vortioxetina/administração & dosagem , Vortioxetina/efeitos adversos , Vortioxetina/farmacocinética , Vortioxetina/farmacologia , Vortioxetina/uso terapêutico , Humanos , Neurotransmissores/metabolismo , AnimaisRESUMO
BACKGROUND: Following traumatic brain injury (TBI) some patients develop lingering comorbid symptoms of fatigue and cognitive impairment. The mild cognitive impairment self-reported by patients is often not detected with neurocognitive tests making it difficult to determine how common and severe these symptoms are in individuals with a history of TBI. This study was conducted to determine the relative prevalence of fatigue and cognitive impairment in individuals with a history of TBI. METHODS: The Fatigue and Altered Cognition Scale (FACs) digital questionnaire was used to assess self-reported fatigue and cognitive impairment. Adults aged 18-70 were digitally recruited for the online anonymous study. Eligible participants provided online consent, demographic data, information about lifetime TBI history, and completed the 20 item FACs questionnaire. RESULTS: A total of 519 qualifying participants completed the online digital study which included 204 participants with a history of TBI of varied cause and severity and 315 with no history of TBI. FACs Total Score was significantly higher in the TBI group (57.7 ± 22.2) compared to non-TBI (39.5 ± 23.9; p<0.0001) indicating more fatigue and cognitive impairment. When stratified by TBI severity, FACs score was significantly higher for all severity including mild (53.9 ± 21.9, p<0.0001), moderate (54.8 ± 24.4, p<0.0001), and severe (59.7 ± 20.9, p<0.0001) TBI. Correlation analysis indicated that more severe TBI was associated with greater symptom severity (p<0.0001, r = 0.3165). Ancillary analysis also suggested that FACs scores may be elevated in participants with prior COVID-19 infection but no history of TBI. CONCLUSIONS: Adults with a history of even mild TBI report significantly greater fatigue and cognitive impairment than those with no history of TBI, and symptoms are more profound with greater TBI severity.
Assuntos
Concussão Encefálica , Lesões Encefálicas Traumáticas , Disfunção Cognitiva , Adulto , Humanos , Concussão Encefálica/complicações , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/complicações , Fadiga/etiologia , Fadiga/complicações , Prevalência , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , IdosoRESUMO
BACKGROUND: Early cognitive deficits commonly seen in older people have not been well defined and managed in primary care. The objectives are (1) to develop and validate a new risk score to estimate the risk of dementia in Chinese older population; and (2) to evaluate the use of risk score in conjunction with cognitive screening in detecting early cognitive deficits in community older people. METHODS: A development cohort of 306 cognitive healthy older adults aged 60 or above were followed for 6 years. A CARS was constructed using the estimated coefficients of risk factors associated with dementia at follow up. Validation was carried out in another five-year cohort of 383 older adults. The usefulness of CARS in detecting early cognitive deficits was evaluated. RESULTS: Risk factors include older age, male gender, low level of education, poorly controlled diabetes, prolonged sleep latency, fewer mind body or light exercise, loneliness, and being apolipoprotein e4 carriers. A cutoff of CARS at -1.3 had a sensitivity of 83.9% and a specificity of 75.4% to predict dementia. The area under curve was 82.5% in the development cohort. Early cognitive deficits were characterized by impaired retention (p <.001, 95% CI 0.2-0.9) and attention (p =.012, 95% CI 0.1-0.8). CONCLUSION: The CARS can be used as a standard risk assessment of dementia or in conjunction with a computerized cognitive screening to evaluate a full cognitive profile for detecting early cognitive deficits. The result put forward the integration of risk algorithm into smart healthcare system to provide personalized lifestyle interventions.
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Disfunção Cognitiva , Demência , Idoso , Humanos , Masculino , Envelhecimento , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/complicações , Demência/diagnóstico , Fatores de Risco , Pessoa de Meia-Idade , FemininoRESUMO
Background and Objectives: Therapeutic hypothermia (TH) shows promise as an approach with neuroprotective effects, capable of reducing secondary brain damage and intracranial pressure following successful mechanical thrombectomy in the acute phase. However, its effect on cognitive impairment remains unclear. This study investigated whether TH can improve cognitive impairment in a mouse model of transient middle cerebral artery occlusion followed by reperfusion (tMCAO/R). Materials and Methods: Nine-week-old C57BL/6N mice (male) were randomly assigned to three groups: sham, tMCAO/R, and tMCAO/R with TH. Cognitive function was assessed 1 month after model induction using the Y-maze test, and regional cerebral glucose metabolism was measured through positron emission tomography with fluorine-18 fluorodeoxyglucose. Results: tMCAO/R induced cognitive impairment, which showed improvement with TH. The TH group exhibited a significant recovery in cerebral glucose metabolism in the thalamus compared to the tMCAO/R group. Conclusions: These findings indicate that TH may hold promise as a therapeutic strategy for alleviating ischemia/reperfusion-induced cognitive impairment.
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Disfunção Cognitiva , Hipotermia Induzida , Fármacos Neuroprotetores , Traumatismo por Reperfusão , Camundongos , Animais , Masculino , Fármacos Neuroprotetores/farmacologia , Camundongos Endogâmicos C57BL , Infarto da Artéria Cerebral Média/tratamento farmacológico , Traumatismo por Reperfusão/complicações , Disfunção Cognitiva/terapia , Disfunção Cognitiva/complicações , GlucoseRESUMO
Background: Mild Traumatic Brain Injury (mTBI) has been increasingly recognized as a public health concern due to its prevalence and potential to induce long-term cognitive impairment. We aimed to consolidate this observation by focusing on findings of neuropsychological assessments, neuroimaging, risk factors, and potential strategies for intervention to prevent and treat mTBI-associated cognitive impairments. Methods: A thorough search of PubMed, PsycINFO, and Embase databases was performed for studies published until 2024. Studies focusing on cognitive impairment after mTBI, with neurocognitive assessment as a primary outcome, were included. Results: We found consistent evidence of cognitive deficits, such as memory and attention impairments, and affected executive functions following mTBI. Neuroimaging studies corroborate these findings, highlighting structural and functional changes in the brain. Several risk factors for developing cognitive impairment post-mTBI were identified, including age, gender, genetics, and pre-existing mental health conditions. The efficacy of interventions, including cognitive rehabilitation and pharmaceutical treatment, varied across studies. Conclusions: Mild TBI can lead to significant long-term cognitive impairments, impacting an individual's quality of life. Further research is necessary to validate and standardize cognitive assessment tools post-mTBI, to elucidate the underlying neural mechanisms, and to optimize therapeutic interventions.
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Concussão Encefálica , Transtornos Cognitivos , Disfunção Cognitiva , Humanos , Concussão Encefálica/complicações , Concussão Encefálica/psicologia , Qualidade de Vida , Disfunção Cognitiva/complicações , Encéfalo , Transtornos Cognitivos/etiologiaRESUMO
BACKGROUND: Life expectancy of patients with congenital heart disease (CHD) has increased rapidly, resulting in a growing and aging population. Recent studies have shown that older people with CHD have higher morbidity, health care use, and mortality. To maintain longevity and quality of life, understanding their evolving medical and psychosocial challenges is essential. OBJECTIVES: The authors describe the frailty and cognitive profile of middle-aged and older adults with CHD to identify predictor variables and to explore the relationship with hospital admissions and outpatient visits. METHODS: Using a cross-sectional, multicentric design, we included 814 patients aged ≥40 years from 11 countries. Frailty phenotype was determined using the Fried method. Cognitive function was assessed by the Montreal Cognitive Assessment. RESULTS: In this sample, 52.3% of patients were assessed as robust, 41.9% as prefrail, and 5.8% as frail; 38.8% had cognitive dysfunction. Multinomial regression showed that frailty was associated with older age, female sex, higher physiologic class, and comorbidities. Counterintuitively, patients with mild heart defects were more likely than those with complex lesions to be prefrail. Patients from middle-income countries displayed more prefrailty than those from higher-income countries. Logistic regression demonstrated that cognitive dysfunction was related to older age, comorbidities, and lower country-level income. CONCLUSIONS: Approximately one-half of included patients were (pre-)frail, and more than one-third experienced cognitive impairment. Frailty and cognitive dysfunction were identified in patients with mild CHD, indicating that these concerns extend beyond severe CHD. Assessing frailty and cognition routinely could offer valuable insights into this aging population.
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Disfunção Cognitiva , Fragilidade , Cardiopatias Congênitas , Idoso , Pessoa de Meia-Idade , Humanos , Feminino , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Fragilidade/complicações , Idoso Fragilizado/psicologia , Estudos Transversais , Qualidade de Vida , Cognição , Disfunção Cognitiva/complicações , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/epidemiologia , Avaliação Geriátrica/métodosRESUMO
Cognitive deficits are a common and debilitating consequence of stroke, yet our understanding of the structural neurobiological biomarkers predicting recovery of cognition after stroke remains limited. In this longitudinal observational study, we set out to investigate the effect of both focal lesions and structural connectivity on poststroke cognition. Sixty-two patients with stroke underwent advanced brain imaging and cognitive assessment, utilizing the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE), at 3-month and 12-month poststroke. We first evaluated the relationship between lesions and cognition at 3 months using voxel-based lesion-symptom mapping. Next, a novel correlational tractography approach, using multi-shell diffusion-weighted magnetic resonance imaging (MRI) data collected at both time points, was used to evaluate the relationship between the white matter connectome and cognition cross-sectionally at 3 months, and longitudinally (12 minus 3 months). Lesion-symptom mapping did not yield significant findings. In turn, correlational tractography analyses revealed positive associations between both MoCA and MMSE scores and bilateral cingulum and the corpus callosum, both cross-sectionally at the 3-month stage, and longitudinally. These results demonstrate that rather than focal neural structures, a consistent structural connectome underpins the performance of two frequently used cognitive screening tools, the MoCA and the MMSE, in people after stroke. This finding should encourage clinicians and researchers to not only suspect cognitive decline when lesions affect these tracts, but also to refine their investigation of novel approaches to differentially diagnosing pathology associated with cognitive decline, regardless of the aetiology.
Assuntos
Transtornos Cognitivos , Disfunção Cognitiva , Acidente Vascular Cerebral , Humanos , Cognição , Encéfalo/diagnóstico por imagem , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/complicações , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/psicologia , Transtornos Cognitivos/diagnóstico por imagem , Transtornos Cognitivos/etiologia , Testes NeuropsicológicosRESUMO
Background: The effect of cholinesterase inhibitor (ChEI) on mild cognitive impairment (MCI) is controversial. Brain age has been shown to predict Alzheimer's disease conversion from MCI. Objective: The study aimed to show that brain age is related to cognitive outcomes of ChEI treatment in MCI. Methods: Brain MRI, the Clinical Dementia Rating (CDR) and Mini-Mental State Exam (MMSE) scores were retrospectively retrieved from a ChEI treatment database. Patients who presented baseline CDR of 0.5 and received ChEI treatment for at least 2 years were selected. Patients with stationary or improved cognition as verified by the CDR and MMSE were categorized to the ChEI-responsive group, and those with worsened cognition were assigned to the ChEI-unresponsive group. A gray matter brain age model was built with a machine learning algorithm by training T1-weighted MRI data of 362 healthy participants. The model was applied to each patient to compute predicted age difference (PAD), i.e. the difference between brain age and chronological age. The PADs were compared between the two groups. Results: 58 patients were found to fit the ChEI-responsive criteria in the patient data, and 58 matched patients that fit the ChEI-unresponsive criteria were compared. ChEI-unresponsive patients showed significantly larger PAD than ChEI-responsive patients (8.44±8.78 years versus 3.87±9.02 years, pâ=â0.0067). Conclusions: Gray matter brain age is associated with cognitive outcomes after 2 years of ChEI treatment in patients with the CDR of 0.5. It might facilitate the clinical trials of novel therapeutics for MCI.
Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Humanos , Inibidores da Colinesterase/uso terapêutico , Estudos Retrospectivos , Doença de Alzheimer/psicologia , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/complicações , Encéfalo/diagnóstico por imagem , CogniçãoRESUMO
Postoperative cognitive dysfunction (POCD) is a common complication following surgery, adversely impacting patients' recovery, increasing the risk of negative outcomes, prolonged hospitalization, and higher mortality rates. The N-methyl-D-aspartate (NMDA) receptor, crucial for learning, memory, and synaptic plasticity, plays a significant role in the development of POCD. Various perioperative factors, including age and anesthetic use, can reduce NMDA receptor function, while surgical stress, inflammation, and pain may lead to its excessive activation. This review consolidates preclinical and clinical research to explore the intricate relationship between perioperative factors affecting NMDA receptor functionality and the onset of POCD. It discusses the influence of aging, anesthetic administration, perioperative injury, pain, and inflammation on the NMDA receptor-related pathophysiology of POCD. The comprehensive analysis presented aims to identify effective treatment targets for POCD, contributing to the improvement of patient outcomes post-surgery.
Assuntos
Anestésicos , Disfunção Cognitiva , Complicações Cognitivas Pós-Operatórias , Humanos , Complicações Cognitivas Pós-Operatórias/etiologia , Receptores de N-Metil-D-Aspartato , Dor/complicações , Inflamação/complicações , Complicações Pós-Operatórias/etiologia , Disfunção Cognitiva/complicaçõesRESUMO
BACKGROUND: Cognitive deficits in bipolar disorder (BD) impact functioning and are main contributors to disability in older age BD (OABD). We investigated the difference between OABD and age-comparable healthy comparison (HC) participants and, among those with BD, the associations between age, global cognitive performance, symptom severity and functioning using a large, cross-sectional, archival dataset harmonized from 7 international OABD studies. METHODS: Data from the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) database, spanning various standardized measures of cognition, functioning and clinical characteristics, were analyzed. The sample included 662 euthymic to mildly symptomatic participants aged minimum 50years (509 BD, 153 HC), able to undergo extensive cognitive testing. Linear mixed models estimated associations between diagnosis and global cognitive performance (g-score, harmonized across studies), and within OABD between g-score and severity of mania and depressive symptoms, duration of illness and lithium use and of global functioning. RESULTS: After adjustment for study cohort, age, gender and employment status, there was no significant difference in g-score between OABD and HC, while a significant interaction emerged between employment status and diagnostic group (better global cognition associated with working) in BD. Within OABD, better g-scores were associated with fewer manic symptoms, higher education and better functioning. LIMITATIONS: Cross-sectional design and loss of granularity due to harmonization. CONCLUSION: More research is needed to understand heterogenous longitudinal patterns of cognitive change in BD and understand whether particular cognitive domains might be affected in OABD in order to develop new therapeutic efforts for cognitive dysfunction OABD.
Assuntos
Transtorno Bipolar , Disfunção Cognitiva , Humanos , Idoso , Transtorno Bipolar/psicologia , Estudos Transversais , Cognição , Envelhecimento/psicologia , Disfunção Cognitiva/complicações , Testes NeuropsicológicosRESUMO
This Viewpoint discusses lecanemab use and the risk of cerebral macrohemorrhage for patients with mild cognitive impairment or early dementia.