Assessment of long-term cognitive dysfunction in older patients who undergo heart surgery.

INTRODUCTION: Older patients are more likely to have cognitive dysfunction, and a great proportion of patients undergone surgical procedures are older adults. Postoperative cognitive dysfunction (POCD) has been shown as a consistent complication after major surgical procedures such as heart surgery. AIM: To determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors. METHODS: We prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery. RESULTS: Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p<0.01), history of smoking (p<0.01), arterial hypertension (p=0.022), diabetes mellitus (p=0.024), heart failure (p=0.036) and preoperative cognitive dysfunction (p<0.01), and surgery-associated aspects such as EuroSCORE (p<0.01) and operation time (p<0.01) were identified as related risk factors. CONCLUSIONS: Older patients who underwent heart surgery had long-term POCD. Both patient- and surgery-related risk factors were established as related risk factors. These findings suggest that the prevalence of cognitive dysfunction after cardiac surgery in older patients could be related to a possible progression to dementia. In addition, many of the risk factors identified may be modifiable but in practice, these patients are not attended to for their possible cognitive impairment.

[Knowledge on stroke in Spanish population. A systematic review]. / Conocimiento sobre el ictus en la población española. Una revisión sistemática.

OBJECTIVES: To analyze by means of a systematic review the general knowledge about strokes of the Spanish population. MATERIALS AND METHODS: A systematic review is performed following PRISMA guidelines and with data from PubMed, Scopus and EMBASE. All studies carried out in Spain, centred around the knowledge of strokes are compiled (terminology, pathophysiology, signs and symptoms, risk factors, treatment, and willingness to make use of the Emergency Services). From the 4,627 articles collected, 21 were ultimately included in this review. RESULTS: In Spain, the term stroke is less known than others such as embolism or cerebrovascular accident. Loss of strength is the most widely recognized symptom, whereas arterial hypertension is the most widely identified risk factor. The least known symptom and risk factor are visual impairment and diabetes mellitus, respectively. When faced with a suspected stroke, the attitude of most respondents is adequate as they decide to go to the hospital or call the Emergency Services. However, in rural areas or in cases in which the symptoms suddenly stop, a greater number of participants choose to go to their family physician. The main sources of information of the participants are their family members and their doctors. CONCLUSIONS: General knowledge about strokes is scarce among the general population. Nonetheless, the attitude of most of the participants is adequate as they choose to contact specialized Emergency Services.

TITLE: Conocimiento sobre el ictus en la población española. Una revisión sistemática.Objetivos. Analizar mediante una revisión sistemática el estado de conocimiento sobre el ictus en la población española. Materiales y métodos. Se ha llevado a cabo una revisión sistemática siguiendo las directrices PRISMA en las bases de datos PubMed, Scopus y EMBASE. Se incorporaron todos los estudios realizados en España que versaran sobre el conocimiento del ictus (terminología, fisiopatología, síntomas y signos, factores de riesgo, tratamiento e intención de acudir a servicios de emergencias). Se identificaron 4.627 artículos, de los cuales 21 se incluyeron finalmente en la revisión. Resultados. El término ictus es menos reconocido que otros, como embolia o infarto cerebral. La pérdida de fuerza es el síntoma más reconocido y la hipertensión arterial es el factor de riesgo más identificado. El síntoma y el factor de riesgo menos reconocidos son los déficits visuales y la diabetes mellitus, respectivamente. Ante la sospecha de ictus, la actitud de la mayoría de los encuestados es adecuada, ya que eligen acudir al hospital o llamar a los servicios de emergencias. Sin embargo, en el medio rural, y ante síntomas que ceden espontáneamente, un mayor número de participantes elige acudir a su médico de familia. Las principales fuentes de información de los participantes son sus familiares y médicos. Conclusiones. El conocimiento global sobre el ictus es escaso entre la población española. Sin embargo, la actitud de la mayoría de los participantes es adecuada, ya que elige mayoritariamente contactar con servicios de emergencias especializados.

Assessment of long-term cognitive dysfunction in older patients who undergo heart surgery.

INTRODUCTION: Older patients are more likely to have cognitive dysfunction, and a great proportion of patients undergone surgical procedures are older adults. Postoperative cognitive dysfunction (POCD) has been shown as a consistent complication after major surgical procedures such as heart surgery. AIM: To determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors. METHODS: We prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery. RESULTS: Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p<0.01), history of smoking (p<0.01), arterial hypertension (p=0.022), diabetes mellitus (p=0.024), heart failure (p=0.036) and preoperative cognitive dysfunction (p<0.01), and surgery-associated aspects such as EuroSCORE (p<0.01) and operation time (p<0.01) were identified as related risk factors. CONCLUSIONS: Older patients who underwent heart surgery had long-term POCD. Both patient- and surgery-related risk factors were established as related risk factors. These findings suggest that the prevalence of cognitive dysfunction after cardiac surgery in older patients could be related to a possible progression to dementia. In addition, many of the risk factors identified may be modifiable but in practice, these patients are not attended to for their possible cognitive impairment.

Glutamate receptors of the A5 region modulate cardiovascular responses evoked from the dorsomedial hypothalamic nucleus and perifornical area.

To assess the possible function of glutamate in the interaction between the dorsomedial hypothalamic nucleus-perifornical area (DMH-PeF) and the A5 pontine region (A5), cardiovascular and respiratory changes were studied in response to electrical stimulation of the DMH-PeF (1 ms pulses, 30-50 µA given at 100 Hz for 5 s) before and after the microinjection of kynurenic acid (non-specific glutamate receptor antagonist; 50 nl, 5 nmol), MK-801 (NMDA receptor antagonist; 50 nl, 50 nmol), CNQX (non-NMDA receptor antagonist; 50 nl, 50 nmol) or MCPG (metabotropic glutamate receptor antagonist; 50 nl, 5 nmol) within the A5 region. DMH-PeF electrical stimulation elicited a pressor (p < 0.001) and tachycardic response (p < 0.001) which was accompanied by an inspiratory facilitation characterised by an increase in respiratory rate (p < 0.001) due to a decrease in expiratory time (p < 0.01). Kynurenic acid within the A5 region decreased the tachycardia (p < 0.001) and the intensity of the blood pressure response (p < 0.001) to DMH-PeF stimulation. After the microinjection of MK-801 and CNQX into the A5 region, the magnitude of the tachycardia and the pressor response were decreased (p < 0.05 and p < 0.01; p < 0.001 and p < 0.05, respectively). After MCPG microinjection into the A5 region, a decrease in the tachycardia (p < 0.001) with no changes in the pressor response was observed during DMH-PeF stimulation. The respiratory response elicited by DMH-PeF stimulation was not changed after the microinjection of kynurenic acid, MK-801, CNQX or MCPG within the A5 region. These results suggest that A5 region glutamate receptors play a role in the cardiovascular response elicited from the DMH-PeF. The possible mechanisms involved in these interactions are discussed.

Neurons of the A5 region are required for the tachycardia evoked by electrical stimulation of the hypothalamic defence area in anaesthetized rats.

In order to assess the possible interactions between the pontine A5 region and the hypothalamic defence area (HDA), we have examined the pattern of double staining for c-Fos protein immunoreactivity (c-Fos-ir) and tyrosine hydroxylase, throughout the rostrocaudal extent of the A5 region in spontaneously breathing anaesthetized male Sprague-Dawley rats during electrical stimulation of the HDA. Activation of the HDA elicited a selective increase in c-Fos-ir with an ipsilateral predominance in catecholaminergic and non-catecholaminergic A5 somata (P < 0.001 in both cases). A second group of experiments was done to examine the importance of the A5 region in modulating the cardiorespiratory response evoked from the HDA. Cardiorespiratory changes were analysed in response to electrical stimulation of the HDA before and after ipsilateral microinjection of muscimol within the A5 region. Stimulation of the HDA evoked an inspiratory facilitatory response, consisting of an increase in respiratory rate (P < 0.001) due to a decrease in expiratory time (P < 0.01). The respiratory response was accompanied by a pressor response (P < 0.001) and tachycardia (P < 0.001). After muscimol microinjection within the A5 region, pressor and heart rate responses to HDA stimulation were reduced (P < 0.01 and P < 0.001, respectively). The respiratory response persisted unchanged. Finally, to confirm functional interactions between the HDA and the A5 region, extracellular recordings of putative A5 neurones were obtained during HDA stimulation. Seventy-five A5 cells were recorded, 35 of which were affected by the HDA (47%). These results indicate that neurones of the A5 region participate in the cardiovascular response evoked from the HDA. The possible mechanisms involved in these interactions are discussed.

Atypical conduction aphasia and the right hemisphere: Cross-hemispheric plasticity of phonology in a developmentally dyslexic and dysgraphic patient with early left frontal damage.

We report the rare case of a patient, JNR, with history of mixed handedness, developmental dyslexia, dysgraphia, and attentional deficits associated with a Klippel-Trenaunay syndrome and a small subcortical frontal lesion involving the left arcuate fasciculus. In adulthood, he suffered a large right perisylvian stroke and developed atypical conduction aphasia with deficits in input and output phonological processing and poor auditory-verbal short-term memory. Lexical-semantic processing for single words was intact, but he was unable to access meaning in sentence comprehension and repetition. Reading and writing deficits worsened after the stroke and he presented a combination of developmental and acquired dysgraphia and dyslexia with mixed lexical and phonological processing deficits. This case suggest that a small lesion sustained prenatally or early in life could induce a selective rightward shift of phonology sparing the standard left hemisphere lateralisation of lexical-semantic functions.

[Prevalence and comorbidity of neuropsychiatric symptoms in Alzheimer's disease]. / Prevalencia y comorbilidad de síntomas neuropsiquiátricos en la enfermedadde Alzheimer.

INTRODUCTION: The objective of this study is to describe the frequency and severity of behavioral and psychological symptoms (BPS) in a group of 125 patients diagnosed of Alzheimer's disease (AD) (DSM-IV-TR and NINCDSADRDA criteria). METHODS: The evaluation of the BPS was carried out using the Neuropsychiatric Inventory (NPI; Cummings et al., 1994). The sociodemographic and personal background data of the patients were gathered and the dementia stage was established with the Global Deterioration Scale (GDS Reisberg, 1982). RESULTS: A total of 122 patients (98%) presented BPS, with an average of five symptoms per patient. Frequency of presentation was the following: apathy (75%), irritability (66%), depression (60%), agitation (55%), anxiety (54%), aberrant motor activity (47%), delirium (38%), sleeping disorders (36%), disinhibition (29%), eating disorders (28%), hallucinations (20%) and euphoria (4%). CONCLUSIONS: These results show the high incidence of BPS in AD patients and point to the necessity and importance of treating these disorders appropriately.