Cognitive impairment and neuropsychiatric symptoms among individuals with history of symptomatic SARS-CoV-2 infection: a retrospective longitudinal study / Comprometimento cognitivo e sintomas neuropsiquiátricos entre indivíduos com histórico de infecção sintomática por SARS-CoV-2: um estudo longitudinal retrospectivo

ABSTRACT. COVID-19 is a multisystem disease caused by the RNA virus (coronavirus 2 or SARS-CoV-2) that can impact cognitive measures. Objective: To identify the main cognitive and neuropsychiatric symptoms in adults who had no cognitive complaints prior to the infection. Specifically, to observe the trajectory of cognitive and neuropsychiatric performance after 6 months. Methods: This is a retrospective longitudinal study. Forty-nine patients (29 reassessed after 6 months), with a positive PCR test, with no prior cognitive complaints that only presented after the infection and without a history of structural, neurodegenerative or psychiatric neurological diseases. A brief cognitive assessment battery (MoCA), the Trail Making Test (TMT-A, B, ∆), and the Verbal Fluency Test were used, as well as the scales (Hospital Anxiety and Depression Scale-HADS, Fatigue Severity Scale-FSS). Correlation tests and group comparison were used for descriptive and inferential statistics. Level of significance of α=5%. Results: Mean age of 50.4 (11.3), 12.7 (2.8) years of education, higher percentage of women (69.8%). No psycho-emotional improvement (depression and anxiety) was observed between the evaluations, and patients maintained the subjective complaint of cognitive changes. The HAD-Anxiety scale showed a significant correlation with TMT-B errors. The subgroup participating in cognitive stimulation and psychoeducation showed improvement in the global cognition measure and the executive attention test. Conclusion: Our results corroborate other studies that found that cognitive dysfunctions in post-COVID-19 patients can persist for months after disease remission, as well as psycho-emotional symptoms, even in individuals with mild infection. Future studies, with an increase in casuistry and control samples, are necessary for greater evidence of these results.

RESUMO. A COVID-19 é uma doença multissistêmica causada pelo vírus RNA (coronavírus 2 ou SARS-CoV-2) que pode ocasionar repercussão em medidas cognitivas. Objetivo: Identificar os principais sintomas cognitivos e neuropsiquiátricos em adultos sem queixas cognitivas anteriores à infecção. Especificamente, verificar a trajetória do desempenho cognitivo e neuropsiquiátrico após 6 meses. Métodos: Trata-se de um estudo retrospectivo e longitudinal. Foram incluídos 49 pacientes (29 reavaliados após 6 meses), com exame de PCR positivo, sem queixas cognitivas prévias que só se apresentaram após a infecção ou histórico de doenças neurológicas estruturais ou neurodegenerativas. Foram utilizados a bateria de avaliação cognitiva breve (MoCA), o Teste de Trilhas (TMT-A, B e ∆) e o Teste de Fluência Verbal; assim como a Escala Hospitalar de Ansiedade e Depressão (HADS), e a escala de Severidade da Fadiga (ESF/BR). Testes de correlação e comparação de grupos foram utilizados para estatística descritiva e inferencial. Esta ocorreu através de. Nível de significância de α=5%. Resultados: idade média de 50,4 anos (11,3), anos de escolaridade 12,7 (2,8), maior proporção de mulheres (69,8%). Não foi observada melhora psicoemocional (depressão e ansiedade) entre as avaliações, assim como os pacientes mantiveram a queixa subjetiva de alteração cognitiva. A escala HAD-Ansiedade apresentou correlação significativa com os erros do TMT-B. O subgrupo que participou da estimulação cognitiva e psicoeducação apresentou melhora na medida de cognição global e no teste de atenção executiva. Conclusão: Nossos resultados corroboram com os demais estudos que constataram que a disfunção cognitiva em pacientes pós-COVID-19 pode persistir por meses após a remissão da doença, assim como sintomas psicoemocionais, mesmo em indivíduos com quadros leves da infecção. Estudos futuros, com aumento de casuística e amostras de controle, são necessários para maior evidência desses resultados.

Long COVID: neurological manifestations - an updated narrative review / COVID longa: manifestações neurológicas - uma revisão narrativa atualizada

ABSTRACT. Infection with the SARS-CoV-2 virus can lead to neurological symptoms in the acute phase and in the Long COVID phase. These symptoms usually involve cognition, sleep, smell disorders, psychiatric manifestations, headache and others. This condition is more commonly described in young adults and women. This symptomatology can follow severe or mild cases of the disease. The importance of this issue resides in the high prevalence of neurological symptoms in the Long COVID phase, which entails significant morbidity in this population. In addition, such a condition is associated with high health care costs, with some estimates hovering around 3.7 trillion US dollars. In this review, we will sequentially describe the current knowledge about the most prevalent neurological symptoms in Long COVID, as well as their pathophysiology and possible biomarkers.

RESUMO. A infecção pelo vírus SARS-CoV-2 pode levar a sintomas neurológicos na fase aguda e na fase de COVID longa. Esses sintomas geralmente envolvem cognição, sono, distúrbios do olfato, manifestações psiquiátricas, dor de cabeça e outros. Esta condição é mais comumente descrita em adultos jovens e mulheres. A sintomatologia pode acompanhar casos graves ou leves da doença. A importância desta questão reside na elevada prevalência de sintomas neurológicos na fase de COVID longa, o que acarreta morbilidade significativa nesta população. Além disso, tal condição está associada a elevados custos de cuidados de saúde, com algumas estimativas em torno de 3,7 trilhões de dólares americanos. Nesta revisão, descrevemos sequencialmente o conhecimento atual sobre os sintomas neurológicos mais prevalentes na COVID longa, bem como sua fisiopatologia e possíveis biomarcadores.

Indicators of functional fitness and cognitive commitment in elderly / Indicadores de aptitud funcional y compromiso cognitivo en ancianos / Indicadores de aptidão funcional e comprometimento cognitivo em idosos

ABSTRACT Introduction: Cognitive losses are among the most prevalent events in the elderly population and can cause functional deficits. Among the available non-drug prevention and treatment alternatives, the increase in functional fitness levels is presented as an important strategy suggesting improvements in the physical and cognitive function of the elderly triggered by exercise. Objective: To determine the predictive power of functional fitness indicators and establish their cutoff points as discriminators of cognitive impairment in the elderly. Methods: The sample comprised 310 elderly people who answered a questionnaire comprising sociodemographic information, lifestyle habits, hospitalization in the last 12 months, presence of comorbidity, and the Mini-Mental State Examination. Functional fitness was assessed using the Hand Grip Strength (HGS) and sitting and rising from a chair tests. To identify predictors of cognitive impairment, analysis of Receiver Operating Characteristic (ROC) curves was adopted, with a confidence interval of 95% (95%CI). Subsequently, the cut-off points with their respective sensitivities and specificities were identified. The analyses were performed respecting the significance level of 5%. Results: It was observed that some functional fitness indicators showed significant Area Under the Curve (AUC), and the sit-and-stand test (AUC=0.72; 95%CI: 0.64-0.77) showed the best results. The best cut-off points for the HGS and sit-and-stand tests were 18,8 kgf and eight repetitions, respectively. Conclusion: The results of the present study allow us to conclude that the sit-to-stand test is moderately efficient in discriminating the presence of cognitive impairment in the elderly. Level of Evidence III; Study Cross-sectional.

RESUMEN Introducción: Las pérdidas cognitivas se encuentran entre los eventos más prevalentes en la población anciana y pueden causar déficits funcionales. Entre las alternativas de prevención y tratamiento no farmacológico disponibles, el aumento de los niveles de condición física funcional se presenta como una estrategia importante que sugiere mejoras en la función física y cognitiva de los ancianos, desencadenada por la práctica de ejercicios. Objetivo: Determinar el poder predictivo de los indicadores de aptitud funcional y establecer sus puntos de corte como discriminadores del deterioro cognitivo en adultos mayores. Métodos: La muestra estuvo compuesta por 310 ancianos que respondieron un cuestionario que comprendía información sociodemográfica, hábitos de vida, hospitalización en los últimos 12 meses, presencia de comorbilidad y el Mini-Examen del Estado Mental. La condición física funcional se evaluó utilizando la fuerza de agarre manual (FAM) y las pruebas de sentarse y levantarse de una silla. Para identificar predictores de deterioro cognitivo, se adoptó el análisis de curvas Receiver Operating Characteristic (ROC), con intervalo de confianza del 95% (IC95%). Posteriormente se identificaron los puntos de corte con sus respectivas sensibilidades y especificidades. Los análisis se realizaron respetando el nivel de significancia del 5%. Resultados: Se observó que algunos indicadores de aptitud funcional mostraron un Área Bajo la Curva (ABC) significativa, y la prueba de sentarse y pararse (ABC=0,72; 95%IC: 0,64-0,77) mostró los mejores resultados. Los mejores puntos de corte para el test FAM y el sit-and-stand test fueron 18,8 kgf y 8 repeticiones, respectivamente. Conclusión: Los resultados del presente estudio permiten concluir que el test sit-to-stand es moderadamente eficiente para discriminar la presencia de deterioro cognitivo en adultos mayores. Nivel de Evidencia III; Estudio Transversal.

RESUMO Introdução: As perdas cognitivas estão entre os eventos mais prevalentes na população idosa, podendo causar déficits funcionais. Dentre as alternativas de prevenção e tratamento não medicamentosos disponíveis, o aumento dos níveis de aptidão funcional apresenta-se como uma estratégia importante sugerindo melhorias na função física e na função cognitiva de idosos, desencadeadas através da prática de exercícios. Objetivo: Determinar o poder preditivo dos indicadores de aptidão funcional e estabelecer seus pontos de corte como discriminadores do comprometimento cognitivo em idosos. Métodos: A amostra compreendeu 310 idosos que responderam a um questionário composto por informações sociodemográficas, hábitos de vida, hospitalização nos últimos 12 meses, presença de comorbidade e o Mini-Exame do Estado Mental. A aptidão funcional foi avaliada por meio dos testes de Força de Preensão Manual (FPM) e o de sentar e levantar da cadeira. Para identificação dos preditores do comprometimento cognitivo, foi adotada a análise das curvas Receiver Operating Characteristic (ROC), com intervalo de confiança de 95% (IC95%). Posteriormente, identificaram-se os pontos de corte com as respectivas sensibilidades e especificidades. As análises foram efetuadas respeitando-se o nível de significância de 5%. Resultados: Observou-se que alguns indicadores de aptidão funcional apresentaram Área Sob a Curva (ASC) significativas, sendo que o teste de sentar e levantar da cadeira (ASC=0,72; IC95%= 0,64-0,77) apresentou os melhores resultados. Os melhores pontos de corte para o teste de FPM e o teste de sentar e levantar da cadeira foram de 18,8 kgf e 8 repetições respectivamente. Conclusão: Os resultados do presente estudo permitem concluir que o teste de sentar e levantar da cadeira apresenta moderada eficiência para discriminar a presença de comprometimento cognitivo em idosos. Nível de Evidência III; Estudo Transversal.

Effect of Qiwei Baizhusan on Cognitive Dysfunction in Rats with Diabetic Encephalopathy Based on PI3K/Akt/GSK-3β Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo observe the therapeutic effect of Qiwei Baizhusan（QWBZS） on diabetic encephalopathy（DE） rat model， and to explore the possible mechanism of QWBZS in the treatment of DE based on phosphatidylinositol 3-kinase（PI3K）/protein kinase B（Akt）/glycogen synthase kinase-3β（GSK-3β） signaling pathway. MethodForty-eight SPF male Wistar rats were randomly divided into blank group（8 rats） and high-fat diet group（40 rats）. After 12 weeks of feeding， rats in the high-fat diet group were intraperitoneally injected with 35 mg·kg-1 of 1% streptozotocin（STZ） for 2 consecutive days to construct a DE model， and rats in the blank group were injected with the same amount of sodium citrate buffer. After successful modeling， according to blood glucose and body weight， model rats were randomly divided into model group， low， medium and high dose groups of QWBZS（3.15， 6.3， 12.6 g·kg-1）， combined western medicine group（metformin+rosiglitazone， 0.21 g·kg-1）， with 6 rats in each group. The administration group was given the corresponding dose of drug by gavage， and the blank group and the model group were given an equal volume of 0.9% sodium chloride solution by gavage， 1 time/day for 6 weeks. Morris water maze was used to detect the spatial memory ability of DE rats. Fasting insulin （FINS） level was detected by enzyme-linked immunosorbent assay（ELISA） and insulin resistance index（HOMA-IR） was calculated. Hematoxylin-eosin（HE） staining was used to observe the morphological changes of hippocampus in rats， ELISA was used to detect the indexes of oxidative stress in hippocampal tissues， real-time fluorescence quantitative polymerase chain reaction（Real-time PCR） was used to detect mRNA expression levels of PI3K， Akt， nuclear transcription factor-κB（NF-κB）， tumor necrosis factor-α（TNF-α） and interleukin-1β（IL-1β） in hippocampus， and Western blot was used to detect the protein expression of PI3K， Akt， phosphorylated（p）-Akt， GSK-3β and p-GSK-3β in hippocampus of rats. ResultCompared with the blank group， FINS and HOMA-IR values of the model group were significantly increased（P<0.01）， the path of finding the original position of the platform was significantly increased， and the escape latency was significantly prolonged（P<0.01）， the morphology of neuronal cells in hippocampal tissues was disrupted， the levels of reactive oxygen species（ROS） and malondialdehyde（MDA） in hippocampus of rats were increased， and the activity of superoxide dismutase（SOD） was decreased（P<0.05， P<0.01）， mRNA expression levels of PI3K and Akt were decreased（P<0.01）， mRNA expression levels of NF-κB， TNF-α and IL-1β were increased（P<0.05， P<0.01）， the protein expression levels of PI3K， p-Akt and p-GSK-3β were significantly decreased， and the protein expression of GSK-3β was significantly increased（P<0.01）. Compared with the model group， the FINS and HOMA-IR values of the medium dose group of QWBZS and the combined western medicine group were significantly decreased（P<0.01）， the path of finding the original position of the platform and the escape latency were significantly shortened（P<0.01）， the hippocampal tissue structure of rats was gradually recovered， and the morphological damage of nerve cells was significantly improved， the contents of ROS and MDA in hippocampus of rats decreased and the level of SOD increased（P<0.01）， the mRNA expression levels of PI3K and Akt were increased（P<0.01）， and the mRNA expression levels of NF-κB， TNF-α and IL-1β were decreased （P<0.05， P<0.01）， the protein expression levels of PI3K， p-Akt and p-GSK-3β were significantly increased（P<0.01）， and the expression of GSK-3β was significantly decreased（P<0.01）. ConclusionQWBZS can alleviate insulin resistance in DE rats， it may repair hippocampal neuronal damage and improve learning and cognitive ability of DE rats by activating PI3K/Akt/GSK-3β signaling pathway.

Prediction of declarative memory profile in panic disorder patients: a machine learning-based approach

Objective: To develop a classification framework based on random forest (RF) modeling to outline the declarative memory profile of patients with panic disorder (PD) compared to a healthy control sample. Methods: We developed RF models to classify the declarative memory profile of PD patients in comparison to a healthy control sample using the Rey Auditory Verbal Learning Test (RAVLT). For this study, a total of 299 patients with PD living in the city of Rio de Janeiro (70.9% females, age 39.9 ± 7.3 years old) were recruited through clinician referrals or self/family referrals. Results: Our RF models successfully predicted declarative memory profiles in patients with PD based on RAVLT scores (lowest area under the curve [AUC] of 0.979, for classification; highest root mean squared percentage [RMSPE] of 17.2%, for regression) using relatively bias-free clinical data, such as sex, age, and body mass index (BMI). Conclusions: Our findings also suggested that BMI, used as a proxy for diet and exercises habits, plays an important role in declarative memory. Our framework can be extended and used as a prospective tool to classify and examine associations between clinical features and declarative memory in PD patients.

Decisiones por sustitución en personas mayores con deterioro cognitivo y su delegación de autonomía ¿representada? / Surrogate decision-making in older people with cognitive impairment and the delegation of their autonomy: is it represented? / As decisões de substituição em idosos com deficiência cognitiva e sua delegação de autonomia ¿representada?

Objetivo: Analizar las consideraciones éticas que surgen en situaciones donde las personas mayores con deterioro cognitivo delegan sus decisiones a terceros. Desarrollo: Trabajo de reflexión basado en una revisión narrativa desde diferentes fuentes de información. El envejecimiento de la población es un fenómeno donde se evidencian múltiples desafíos a atender. Chile se encuentra en una etapa de envejecimiento avanzado estimando una esperanza de vida sobre los 85 años para el 2050. La Organización Mundial de la Salud promueve el envejecimiento saludable mediante el fortalecimiento de la capacidad funcional como indicador de bienestar. Existen ocasiones donde las personas mayores delegan a un tercero su capacidad de decidir. Las decisiones por sustitución, que abordan dimensiones éticas y legales deben proteger la dignidad de la persona en todo momento, independientemente de su condición de salud y representar plenamente el derecho de autonomía cedido. Conclusiones. La discusión sobre las decisiones por sustitución y la protección de la autonomía, incluso en situaciones de limitaciones cognitivas, subraya la necesidad de tratar a las personas mayores con respeto y ética, desafiando los estereotipos negativos y evitando conductas discriminatorias y estigmatizantes. La importancia de promover la igualdad, inclusión, información y el respeto de los derechos de las personas mayores tiene un impacto directo en el bienestar y calidad de vida, elemento fundamental que la salud pública promueve bajo el contexto del envejecimiento activo, saludable y digno.

Objective: To analyze the ethical considerations in situations where older people with cognitive impairment delegate their decisions to third parties. Development: Reflective practice based on a narrative review of different sources of information. Population aging is a phenomenon where multiple challenges need to be addressed. Chile is at an advanced stage of population aging, with an estimated life expectancy of over 85 years to be reached by 2050. The World Health Organization (WHO) promotes healthy aging by strengthening functional capacity as an indicator of well-being. There are circumstances in which older people delegate their decision-making capacity to a third party. Surrogate decision-making, with its ethical and legal dimensions, should protect the person's dignity at all times, regardless of the state of their health, and fully represent their ceded right of autonomy. Conclusions: The discussion on surrogate decision-making and the protection of autonomy, even in the context of cognitive impairment, highlights the need to treat older people ethically and respectfully, challenging negative stereotypes and avoiding discriminatory and stigmatizing behaviors. Promoting equality, inclusion, information, and respect for the rights of older adults has a direct impact on their well-being and quality of life, which are fundamental elements that public health promotes in the context of active, healthy, and dignified aging.

Objetivo: Analisar as considerações éticas que surgem em situações em que pessoas idosas com deficiência cognitiva delegam as suas decisões a terceiros. Desenvolvimento: Trabalho de reflexão baseado numa revisão narrativa a partir de diferentes fontes de informação. O envelhecimento da população é um fenómeno onde existem múltiplos desafios a enfrentar. O Chile encontra-se numa fase avançada de envelhecimento, estimando uma esperança de vida superior a 85 anos até 2050. A Organização Mundial de Saúde promove o envelhecimento saudável através do fortalecimento da capacidade funcional como indicador de bem-estar. Há ocasiões em que os idosos delegam a sua capacidade de decisão a terceiros. As decisões de substituição, que abordam as dimensões éticas e legais, devem proteger a dignidade da pessoa em todos os momentos, independentemente do seu estado de saúde, e representar plenamente o direito concedido à autonomia. Conclusões: A discussão sobre as decisões de substituição e a proteção da autonomia, mesmo em situações de limitações cognitivas, sublinha a necessidade de tratar os idosos com respeito e ética, desafiando estereótipos negativos e evitando comportamentos discriminatórios e estigmatizantes. A importância da promoção da igualdade, da inclusão, da informação e do respeito pelos direitos dos idosos tem impacto direto no bem-estar e na qualidade de vida, elemento fundamental que a saúde pública promove no contexto do envelhecimento ativo, saudável e digno.

Cognitive impairment in post-acute COVID-19 syndrome: a scoping review / Comprometimento cognitivo na síndrome pós-COVID-19 aguda: uma revisão de escopo

Abstract Emerging studies indicate the persistence of symptoms beyond the acute phase of COVID-19. Cognitive impairment has been observed in certain individuals for months following infection. Currently, there is limited knowledge about the specific cognitive domains that undergo alterations during the post-acute COVID-19 syndrome and the potential impact of disease severity on cognition. The aim of this review is to examine studies that have reported cognitive impairment in post-acute COVID-19, categorizing them into subacute and chronic phases. The methodology proposed by JBI was followed in this study. The included studies were published between December 2019 and December 2022. The search was conducted in PubMed, PubMed PMC, BVS - BIREME, Embase, SCOPUS, Cochrane, Web of Science, Proquest, PsycInfo, and EBSCOHost. Data extraction included specific details about the population, concepts, context, and key findings or recommendations relevant to the review objectives. A total of 7,540 records were identified and examined, and 47 articles were included. The cognitive domains most frequently reported as altered 4 to 12 weeks after acute COVID-19 were language, episodic memory, and executive function, and after 12 weeks, the domains most affected were attention, episodic memory, and executive function. The results of this scoping review highlight that adults with post-acute COVID-19 syndrome may have impairment in specific cognitive domains.

Resumo Estudos emergentes indicam a persistência dos sintomas além da fase aguda da COVID-19. O comprometimento cognitivo foi observado em alguns indivíduos durante meses após a infecção. Atualmente, há pouco conhecimento sobre os domínios cognitivos específicos que sofrem alterações durante a síndrome pós-aguda da COVID-19 e o possível impacto da gravidade da doença na cognição. O objetivo desta revisão é examinar estudos que relataram comprometimento cognitivo na COVID-19 pós-aguda, categorizando-os em fases subaguda e crônica. A metodologia proposta pela Joanna Briggs Institute foi seguida neste estudo. Os estudos incluídos foram publicados entre dezembro de 2019 e dezembro de 2022. A busca foi realizada no PubMed, PubMed PMC, BVS - BIREME, Embase, SCOPUS, Cochrane, Web of Science, Proquest, PsycInfo e EBSCOHost. A extração de dados incluiu detalhes específicos sobre a população, os conceitos, o contexto e as principais descobertas ou recomendações relevantes para os objetivos da revisão. Um total de 7.540 registros foi identificado e examinado, e 47 artigos foram incluídos. Os domínios cognitivos mais frequentemente relatados como alterados de 4 a 12 semanas após a COVID-19 aguda foram linguagem, memória episódica e função executiva e, após 12 semanas, os domínios mais afetados foram atenção, memória episódica e função executiva. Os resultados dessa revisão de escopo destacam que adultos com síndrome pós-aguda da COVID-19 podem apresentar comprometimento em domínios cognitivos específicos.

Enfermedad de pequeño vaso. Relación con deterioro funcional, cognitivo y afectivo en adultos mayores con enfermedad cerebrovascular / Small vessel disease. Relationship with functional, cognitive and affective impairment in elderly adults with cerebrovascular disease

INTRODUCCIÓN: La enfermedad cerebral de pequeño vaso es una causa principal de pérdida funcional, discapacidad y deterioro cognitivo. OBJETIVO: Determinar la prevalencia de la enfermedad de pequeño vaso y características clínicas que se asocian a mayor deterioro funcional, cognitivo y afectivo en adultos mayores con enfermedad cerebrovascular atendidos en el Servicio de Neurología del Hospital Carlos Andrade Marín en el período 2020 ­ 2021. METODOLOGÍA: Estudio observacional, analítico transversal con 80 pacientes mayores de 65 años con enfermedad cerebrovascular previamente diagnosticada. Se determinó cuáles presentaban enfermedad cerebral de pequeño vaso. Se compararon los dos grupos el de enfermedad cerebro vascular isquémico con y sin enfermedad cerebral de pequeño vaso. Se midió el grado de deterioro funcional con escala de Barthel; Lawton y Brody. El deterioro cognitivo con test de Montreal Cognitive Assessment ­Basic, estado afectivo con escala de Yesavage. Se utilizó razón de momios y se consideró significativo un valor p <0,05. Se utilizó el programa Statistical Package for Social Sciences versión 25. RESULTADOS: Los hombres representaron el 51,2%. La edad promedio fue 76,2 años. Prevalencia de enfermedad cerebral de pequeño vaso (87,5%). Escala de Fazekas grado 1 (46,3%), Factores asociados con enfermedad cerebral de pequeño vaso: tabaquismo [RR: 7,27; IC 95%: 1,69-31,3); enfermedad renal crónica [RR: 4,0; IC 95%: 1,01-15,7]. Dependencia moderada [RR: 6,42; IC 95%: 1,02-40,3]. Factores asociados con pérdida funcionalidad: gravedad del ictus. Factores asociados con deterioro cognitivo: infarto con doble territorio. Factores asociados con deterioro afectivo: infarto con doble territorio y síndrome metabólico (p<0,05). CONCLUSIÓN: La enfermedad cerebral de pequeño vaso tiene una elevada prevalencia entre los adultos mayores con enfermedad cerebrovascular y representó un deterioro cognitivo, funcional y afectivo considerable, en relación a los pacientes sin esta enfermedad.

INTRODUCTION: Cerebral small vessel disease is a leading cause of functional loss, disability, and cognitive impairment. OBJECTIVE: To determine the prevalence of small vessel disease and clinical characteristics associated with greater functional, cognitive and affective impairment in older adults with cerebrovascular disease attended at the Neurology Service of the Carlos Andrade Marín Hospital in the period 2020 - 2021. METHODOLOGY: Observational, analytical cross-sectional study with 80 patients over 65 years of age with previously diagnosed cerebrovascular disease. It was determined which patients had cerebral small vessel disease. The two groups of ischemic cerebrovascular disease with and without cerebral small vessel disease were compared. The degree of functional impairment was measured with the Barthel, Lawton and Brody scales. Cognitive impairment was measured with the Montreal Cognitive Assessment-Basic test, and affective state with the Yesavage scale. Odds ratio was used and a p value <0,05 was considered significant. Statistical Package for Social Sciences version 25 was used. RESULTS: Males represented 51,2%. Mean age was 76,2 years. Prevalence of cerebral small vessel disease (87,5%). Fazekas scale grade 1 (46,3%), Factors associated with cerebral small vessel disease: smoking [RR: 7,27; 95% CI: 1,69-31,3); chronic kidney disease [RR: 4,0; 95% CI: 1,01-15,7]. Moderate dependence [RR: 6,42; 95% CI: 1,02-40,3]. Factors associated with loss of function: severity of stroke. Factors associated with cognitive impairment: infarction with double territory. Factors associated with affective impairment: dual territory infarction and metabolic syndrome (p<0.05). CONCLUSION: Cerebral small vessel disease has a high prevalence among older adults with cerebrovascular disease and represented a considerable cognitive, functional and affective deterioration, in relation to patients without this disease.

"I don't have Huntington's disease": the boundaries between acceptance and understanding / "Eu não tenho doença de Huntington": os limites entre aceitação e compreensão

Abstract Huntington's disease (HD) is an inherited disease that leads to an inexorable progression of motor, cognitive and psychiatric disturbances. In the initial stages, the symptoms are not clearly disabling, and the patient may present a lack of awareness about the symptoms themselves, which we call anosognosia. However, anosognosia might not justify all passivity of the HD patient in face of the diagnosis. Patients may also experience the denial of illness, as a stage of grief, expected to happen in the face of the diagnosis of any neurodegenerative disorder. In addition, people with HD tend to be more apathetic, and more silent, in regular consultations. In the present article, the authors express a point of view, discussing the behavior of the HD patient, in which there is a multifactorial passivity, in the face of the diagnosis and of the disease itself. Having the proper knowledge of this situation may prepare the neurologist to better understand the patient and the evolution of the disease.

Resumo A doença de Huntington (DH) é uma doença hereditária que leva a uma progressão inexorável de distúrbios motores, cognitivos e psiquiátricos. Nos estágios iniciais, os sintomas não são claramente incapacitantes e há uma falta de consciência sobre os próprios sintomas, o que chamamos de anosognosia. No entanto, anosognosia pode não justificar toda a passividade do paciente de HD diante do diagnóstico. Os pacientes também podem vivenciar a negação da doença, como um estágio de luto, o que é esperado acontecer diante do diagnóstico de qualquer doença neurodegenerativa. Além disso, as pessoas com DH tendem a ficar mais apáticas, mais silenciosas, nas consultas regulares. No presente artigo, os autores expressam um ponto de vista, discutindo acerca do comportamento do paciente com DH, em que há uma passividade multifatorial, frente ao diagnóstico e diante da doença em si. Ter conhecimento sobre essa situação pode preparar o neurologista para entender melhor o paciente e a evolução da doença.

Deterioro cognitivo leve de tipo amnésico en ancianos de un área de salud / Amnestic mild cognitive impairment in elderly of a health area i: en

Introducción: La edad es el factor de riesgo más importante asociado al deterioro cognitivo. Al respecto, la pérdida de la memoria resulta un motivo frecuente y creciente de atención en las consultas médicas del nivel primario. Sin embargo, la disfunción cognitiva en los ancianos suele ser una de las afecciones que transcurren usualmente sin un diagnóstico oportuno. Objetivo: Determinar la prevalencia del deterioro cognitivo leve de tipo amnésico en ancianos de un área de salud. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 203 ancianos pertenecientes al área de salud del Policlínico Docente Ramón López Peña de Santiago de Cuba, desde junio hasta diciembre de 2022. Para diagnosticar a los pacientes con disfunción cognitiva leve se utilizaron los criterios de Petersen. Resultados: Se halló que 36,9 % de los ancianos presentaron deterioro cognitivo leve de tipo amnésico, con predominio del sexo masculino (43,6 %) y del nivel de escolaridad primario (50,0 %), seguido del medio (40,3 %). Conclusiones: El deterioro cognitivo leve de tipo amnésico prevaleció en más de un tercio de la muestra estudiada; frecuencia que aumentó según la edad. Asimismo, se detectó una mayor incidencia del sexo masculino y de los ancianos con escolaridad primaria y media finalizadas.

Introduction: Age is the most important risk factor associated with cognitive deterioration. In this regard, loss of memory is a frequent and growing reason for attention in medical consultations of primary care. However, cognitive dysfunction in the elderly is one of the affections that usually go without an opportune diagnosis. Objective: To determine the prevalence of the amnestic mild cognitive impairment in elderly of a health area. Methods: An observational, descriptive and cross-sectional study of 203 elderly, belonging to the health area of Ramón López Peña Teaching Polyclinic was carried out in Santiago de Cuba, from June to December, 2022. To diagnose the patients with light cognitive dysfunction the Petersen approaches were used. Results: It was found that 36.9% of the elderly presented amnestic mild cognitive impairment, with a prevalence of male sex (43.6%) and the primary school level (50.0%), followed by the middle level (40.3%). Conclusions: Amnestic mild cognitive impairment prevailed in more than a third of the studied sample; frequency that increased according to the age. Likewise, a higher incidence of male sex and the elderly with concluded primary and middle schooling was detected.

Asociación entre el polimorfismo Val66Met del gen BDNF y el desarrollo de disfunción ejecutiva en pacientes con cáncer de mama

Introducción. La disfunción ejecutiva asociada a quimioterapia es un efecto adverso del tratamiento antineoplásico convencional y afecta a un porcentaje considerable de personas. Se ha reportado que la presencia de ciertos polimorfismos en genes relevantes puede causar mayor susceptibilidad a padecerlo. Objetivo. Determinar la relación entre el polimorfismo Val66Met (196 G>A) del gen BDNF y el desarrollo de disfunción ejecutiva en mujeres con cáncer de mama tratadas con quimioterapia. Métodos. Se evaluaron a 73 pacientes mujeres con cáncer de mama para determinar disfunción ejecutiva antes y después de la quimioterapia. La evaluación fue realizada con la prueba INECO Frontal Screening (IFS). Se determinó el genotipo (GG=Val/Val, GA=Val/Met y AA=Met/Met) por PCR y secuenciamiento del gen BDNF. El análisis de asociación se realizó mediante el cálculo del odds ratio (OR). Resultados. El 13,7% (n = 10) de pacientes presentó el alelo A (GA y AA), además obtuvieron puntajes significativamente menores de la prueba IFS comparado con las homocigotas GG (p A) del gen BDNF y el desarrollo de disfunción ejecutiva en pacientes con cáncer de mama tratadas con quimioterapia; sin embargo, las portadoras del alelo A (Met) presentaron puntajes menores en la evaluación cognitiva.

Introduction. Chemotherapy-associated executive dysfunction is an adverse effect of conventional antineoplastic treatment that affects many patients. It has been reported that the presence of specific polymorphisms in key genes can cause a greater susceptibility to develop this condition. Objective. To determine the relationship between the Val66Met polymorphism (196 G>A) of the BDNF gene and the development of executive dysfunction in female patients with breast cancer treated with chemotherapy. Methods. 73 female breast cancer patients were evaluated for executive dysfunction before and after chemotherapy. The evaluation was carried out with the INECO Frontal Screening test (IFS). The genotype (GG=Val/Val, GA=Val/Met and AA=Met/Met) was determined by PCR and sequencing of BDNF gene. Association analysis was performed by calculating the Odds Ratio (OR) and by quantitative comparison. Results. 13.7% (n = 10) of the sample presented the allele A (GA and AA), which obtained significantly lower scores in the IFS test compared to the homozygous GG (p A) polymorphism of the BDNF gene and the development of executive dysfunction in patients with breast cancer treated with chemotherapy. However, patients with the allele A (Met) presented significant lower scores in the cognitive assessment.

Cognitive impairment in multiple sclerosis: "classic" knowledge and recent acquisitions / Deficiência cognitiva na esclerose múltipla: conhecimentos "clássicos" e aquisições recentes

Abstract Multiple sclerosis (MS) is a central nervous system (CNS) disease characterized by inflammation, axonal demyelination, and neurodegeneration, which can have a strong impact on all aspects of the life of the patient. Multiple sclerosis causes motor, sensory, cerebellar, and autonomic dysfunctions, as well as cognitive and psychoemotional impairment. The most frequently compromised cognitive domains are complex attention/information processing, memory, executive and visuospatial functions. Recently, alterations have also been evidenced in complex cognitive functions, such as social cognition, moral judgment, and decision-making. Cognitive impairment is characterized by high variability and can affect work skills, social interactions, coping strategies and more generally the quality of life of patients and their families. With the use of sensitive and easy-to-administer test batteries, an increasingly accurate and early diagnosis is feasible: this allows to determine the effectiveness of possible preventive measures, to predict the future progression of the disease and to improve the quality of life of patients. There is currently limited evidence regarding the efficacy, on cognitive impairment, of disease-modifying therapies. The most promising approach, which has received strong empirical support, is cognitive rehabilitation.

Resumo A esclerose múltipla (EM) é uma doença do sistema nervoso central (SNC) caracterizada por inflamação, desmielinização axonal e neurodegeneração, que pode ter um forte impacto em todos os aspectos da vida dos pacientes. A EM causa disfunções motoras, sensoriais, cerebelares, autonômicas, comprometimento cognitivo e déficits psicoemocionais. Os domínios cognitivos mais frequentemente comprometidos são a atenção complexa/processamento da informação, memória, funções executivas e habilidades visuais-espaciais. Recentemente, também foram evidenciadas alterações em funções cognitivas complexas, como cognição social, julgamento moral e tomada de decisão. O comprometimento cognitivo é caracterizado por alta variabilidade e pode afetar as habilidades laborais, as interações sociais, as estratégias de enfrentamento e, de forma mais geral, a qualidade de vida dos pacientes e de seus familiares. Com o uso de baterias de testes sensíveis e fáceis de administrar, é viável um diagnóstico cada vez mais preciso e precoce: isso permite determinar a eficácia de possíveis medidas preventivas, prever a progressão futura da doença e melhorar a qualidade de vida dos pacientes. Atualmente, há evidências limitadas sobre a eficácia, no comprometimento cognitivo, de terapias modificadoras da doença. A abordagem mais promissora, que tem recebido forte apoio empírico, é a reabilitação cognitiva.

Associations between cognitive impairment and computed tomography perfusion in different lobes in acute stroke of the anterior circulation / Associações entre déficit cognitivo e perfusão de tomografia computadorizada em diferentes lobos no AVC agudo da circulação anterior

Abstract Background Cognitive impairment (CI) during the acute phase of stroke should not be ignored. The present study analyzed the relationship between computed tomography perfusion (CTP) in different lobes and CI during the acute phase of stroke in patients with cerebral infarction. Methods The present study included 125 subjects: 96 in the acute phase of stroke and 29 elderly healthy subjects as a control group. The Montreal Cognitive Assessment (MoCA) was used to evaluate the cognitive status of the two groups. The CTP scans include four parameters: cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and mean transit time (MTT). Results The MoCA scores for naming, language and delayed recall significantly decreased only in patients with left cerebral infarctions. The MTT of the left vessels in the occipital lobe and the CBF of the right vessels in the frontal lobe were negatively related to the MoCA scores of patients with left infarction. The CBV of the left vessels in the frontal lobe and the CBF of left vessels in the parietal lobe were positively linked to the MoCA scores of patients with left infarction. The CBF of the right vessels in the temporal lobe was positively related to the MoCA scores of patients with right infarction. Finally, the CBF of the left vessels in the temporal lobe was inversely correlated with the MoCA scores of patients with right infarctions. Conclusion During the acute phase of stroke, CTP was closely associated with CI. Changed CTP could be a potential neuroimaging biomarker to predict CI during the acute phase of stroke.

Resumo Antecedentes O comprometimento cognitivo (CC) durante a fase aguda do acidente vascular cerebral (AVC) não deve ser ignorado. O presente estudo analisou a relação entre perfusão por tomografia computadorizada (PTC) em diferentes lobos e CC durante a fase aguda do AVC em pacientes com infarto cerebral. Métodos O presente estudo incluiu 125 indivíduos: 96 na fase aguda do AVC e 29 idosos saudáveis como grupo controle. O Montreal Cognitive Assessment (MoCA) foi usado para avaliar o estado cognitivo dos dois grupos. Os exames de PCT incluem quatro parâmetros: fluxo sanguíneo cerebral (FSC), volume sanguíneo cerebral (VSC), tempo até o pico (TAP) e tempo médio de trânsito (TMT). Resultados Os escores do MoCA para nomeação, linguagem e recordação tardia diminuíram significativamente apenas em pacientes com infarto cerebral esquerdo. O TMT dos vasos esquerdos no lobo occipital e o FSC dos vasos direitos no lobo frontal foram negativamente relacionados aos escores MoCA de pacientes com infarto esquerdo. A VSC dos vasos esquerdos em o lobo frontal e o FSC dos vasos esquerdos no lobo parietal foram positivamente ligados aos escores MoCA de pacientes com infarto esquerdo. O FSC dos vasos direitos no lobo temporal foi positivamente relacionado com os escores MoCA de pacientes com infarto direito. Finalmente, o FSC dos vasos esquerdos no lobo temporal foi inversamente correlacionado com os escores MoCA de pacientes com infartos direitos. Conclusão Durante a fase aguda do AVC, a PCT esteve intimamente associada ao CC. O PCT alterado pode ser um potencial biomarcador de neuroimagem para prever CC durante a fase aguda do AVC.

Corioamnionitis histológica y neurodesarrollo en niños prematuros menores de 34 semanas, Lima-Perú

Para determinar los efectos de la corioamnionitis histológica en el neurodesarrollo de los prematuros menores de 34 semanas evaluados a los 2 años de edad corregida se realizó un estudio secundario de casos y controles. Fueron analizados los datos clínicos, hallazgos histológicos de la placenta e índices del desarrollo medidos por la Escala Bayley III de 38 niños expuestos y 53 niños no expuestos. Las infecciones genitourinarias de la madre y la sepsis precoz fueron más frecuentes en el grupo expuesto (p<0,005). Las dimensiones del desarrollo cognitivo, motor y lenguaje fueron normales en ambos grupos. Los expuestos al subtipo subcorionitis obtuvieron menor desempeño en las tres dimensiones. La corioamnionitis histológica no mostró influencia sobre el neurodesarrollo en prematuros menores de 34 semanas a los 2 años de edad. Se recomienda estudios longitudinales y multicéntricos para definir los efectos a largo plazo.

SUMMARY The objective of this study was to determine the effects of histologically diagnosed chorioamnionitis on neurodevelopment of premature babies born with less than 34-week gestational age who were assessed at two-year corrected age. A secondary case-control study was carried out. Clinical data, placental histological findings, and development indexes assessed using the Bayley III scale were analyzed in 38 exposed children and 53 non-exposed children. Genitourinary infections in mothers and early sepsis were more frequent in the exposed group (p<0.005). Cognitive development, motor development and language were normal in both groups. Those children exposed to the chorionitis subtype had lower scores in the aforementioned variables. Histologically diagnosed chorioamnionitis did not show any influence on neurodevelopment in premature babies born with less than 34-week gestational age when they were assessed at two years. Longitudinal and multicenter studies are advised in order to define the long-term effects.

Evaluación de síntomas neuropsiquiátricos para la detección temprana de trastorno neurocognoscitivo / Evaluation of neuropsychiatry symptoms for the early detection of neurocognitive disorder

RESUMEN INTRODUCCIÓN: El diagnóstico oportuno del trastorno neurocognitivo es de los principales retos en la atención de los trastornos neurocognitivos. Por esto, se han generado estrategias para la detección preclínica de la enfermedad, entre ellas las destinadas a evaluar síntomas neuropsiquiátricos (NPS) como la escala Mild Behavior Impairment - Checklist (MBI-C). MÉTODOS: Inicialmente se realizó una búsqueda en BVSalud, Medline y PsycNet, luego se realizó una búsqueda en bola de nieve. Se incluyeron términos referentes a deterioro comportamental leve (abarcando los NPS en etapas tempranas), deterioro cognitivo leve y términos específicos del MBI-C. RESULTADOS: La presencia de NPS se asocia con un aumento en la incidencia anual de demencia. Al evaluarlos con MBI-C, su puntuación se correlaciona con biomarcadores como una mayor atrofia cortical, la presencia de la proteína β-amiloide, así como disminución en funciones ejecutivas como la capacidad de enfocar la atención y la memoria de trabajo. DISCUSIÓN: Los hallazgos en la literatura sugieren la utilidad de MBI-C como marcador de neurodegeneración en estadios previos a la demencia, esto mediante la evaluación de su capacidad predictiva de forma independiente y al compararla con otros biomarcadores. CONCLUSIONES: MBI-C supone ser un instrumento de fácil aplicabilidad e interpretación, sostenible e incluyente. Sin embargo, quedan vacíos sobre la pertinencia de esta escala, por lo que surge la necesidad de investigar este tema.

ABSTRACT INTRODUCTION: Early diagnosis of neurocognitive disorder is the main challenge of dementia health attention. Therefore, strategies for preclinical detection of the disease have been created, like those intended to evaluate neuropsychiatric symptoms (NPS), like the Mild Behavior Impairment - Checklist (MBI-C). METHODS: Research was performed in BVSalud, Medline, and Psynet. Then a snowball sampling was done. The terms included were mild behavioral impairment (included NPS in initial stages), mild cognitive impairment, and specific terms of MBI-C. RESULTS: The presence of NPS increase the incidence of dementia, with an annual conversion rate of 9%. About MBI-C, the score has been related to biomarkers like worse brain atrophy in patients with Parkinson's Disease and a positive relationship with the presence of B-amyloid protein. Also, Creese and cols. show that mild behavioral impairment (measured by MBI-C) is associated with a faster decrease in attention and working memory. DISCUSSION: MBI-C utility as a neurodegenerative marker has been demonstrated to detect cognitive, neuropsychiatry, and functional symptoms that may precede dementia by evaluating its predictive capacity alone and comparing it to other biomarkers. CONCLUSION: MBI-C is easy to apply and interpret, is sustainable and inclusive. However, there are still gaps in the relevance of the scale, so there is the need to continue investigating this topic.

Evaluation of comorbid diseases in obstructive sleep apnea syndrome

SUMMARY OBJECTIVE: It is known that obstructive sleep apnea syndrome affects many systems due to hypoxemia and hypercarbia. We aimed to demonstrate with the utilization of well-standardized questionnaire tools and electrophysiological tests that cognitive impairment, depression, autonomic dysfunction, and metabolic syndrome may occur in association with obstructive sleep apnea syndrome. METHODS: The electrophysiological examination protocol of autonomic nervous system functions was performed with sympathetic skin response and R-R Interval. Patients were administered Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Montreal Cognitive Assessment, and Hamilton Depression Rating Scale by physicians in face-to-face interviews. RESULTS: This study included 148 participants, consisting of 73 patients and 75 controls. There was a statistically significant difference between the patient group and control group with regard to sympathetic skin response, R-R Interval, post-hyperventilation R-R Interval, and R-R Interval variation (p<0.001). A statistically significant difference was observed between the patient group and control group in terms of median Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Montreal Cognitive Assessment scores. It was observed that the control group achieved significantly better scores than the patient group in delayed recall (p<0.001) and language (p<0.05) categories. CONCLUSION: Obstructive sleep apnea syndrome patients should be screened for diseases, especially in the cardiovascular system, that cause serious morbidity and impair functionality such as dementia and depression. We believe that many comorbid diseases encountered in obstructive sleep apnea syndrome patients can be prevented with early diagnosis and continuous positive airway pressure treatment.

Treinamento de força com e sem instabilidade não melhora os níveis gerais de capacidade intrínseca em idosos com queixas cognitivas / Resistance training with and without instability does not improve overall levels of intrinsic capacity in older adults with cognitive complaints

INTRODUÇÃO: Capacidade intrínseca (CI) é um construto que engloba capacidades físicas e mentais para o autocuidado e envelhecimento saudável. A compreensão do papel potencial do treinamento resistido, com e sem instabilidade, para promover o CI precisa ser esclarecida. OBJETIVO: Avaliar o impacto do treinamento de força sobre os níveis de capacidade intrínseca em idosos com queixas cognitivas. MÉTODOS: Idosos com queixas cognitivas (n=67) foram aleatoriamente designados para 12 semanas de TF tradicional (n=23), TF com dispositivos de instabilidade (TFI) (n=22) ou controle (n=22). Ambos os grupos de treinamento realizaram três séries de 10- 15 repetições. O grupo TFI realizou exercícios utilizando dispositivos de instabilidade. O grupo controle recebeu aulas semanais de educação em saúde. Os domínios da CI foram de mobilidade e velocidade da marcha (locomotora), função global e executiva (cognitivo), força de preensão e teste de caminhada de seis minutos (vitalidade), e sintomas depressivos e autoeficácia (psicológicos) por meio de escores-z compostos. Calculamos os níveis globais de CI pela soma de cada pontuação composta. RESULTADOS: Diferença significativa intragrupo nos níveis gerais de CI (∆TFI = +1.69, ∆TF = +1.30) e seus respectivos domínios (Locomoção: ∆TFI = +2.32, ∆TF = +3.21; Cognição: ∆TFI = +2.31; Vitalidade: ∆TFI = +1.23, ∆TF = +1.42; e Psicológico: ∆TFI = -0.65, ∆TF = -0.62). Contudo, não houve diferenças entre os grupos. Análise de sensibilidade mesclando os grupos de treinamento revelou diferença significativa para o domínio locomotor após 12 semanas (+1.97, p=0.045). CONCLUSÃO: Treinamento de força com e sem dispositivos de instabilidade não melhorou os níveis de CI em idosos com queixas cognitivas.

INTRODUCTION: Intrinsic capacity (IC) is a construct that encompasses physical and mental capacities important for self-care and healthy aging. Understanding the potential role of resistance training with and without instability to promote IC needs to be clarified. OBJECTIVE: To assess the impact of resistance training on intrinsic capacity levels in older adults with cognitive complaints. METHODS: Older adults with cognitive complaints (n=67) were randomly assigned to either 12 weeks of traditional RE (n=23), RE with instability devices (REI) (n=22), or control (n=22). Both training groups performed three sets of 10-15 repetitions. REI group performed each exercise using instability devices. The control group received weekly health education classes. IC domains were analyzed using mobility and gait velocity (locomotor), global and executive functioning (cognitive), grip strength and six-minute walking test (vitality), and depressive symptoms and self-efficacy (psychological) through z-composite scores. We computed global levels of IC by the sum of each composite score. RESULTS: A significant within-group difference (improvement) in overall levels of IC (∆REI = +1.69, ∆RE = +1.30) and all their domains (Locomotion: ∆REI = +2.32, ∆RE = +3.21; Cognition: ∆REI = +2.31; Vitality: ∆REI = +1.23, ∆RE = +1.42; and Psychological: ∆REI = -0.65, ∆RE = -0.62). However, no between-group differences were observed at the completion of the trial. Sensitivity analysis merging training groups revealed a between-group difference for the locomotor domain (+1.97, p=0.045). CONCLUSION: Resistance training with and without instability devices did not improve IC levels among older adults with cognitive complaints.

Is there a link between heart rate variability and cognitive decline? A cross-sectional study on patients with mild cognitive impairment and cognitively healthy controls / Existe uma ligação entre a variabilidade da frequência cardíaca e o declínio cognitivo? Um estudo transversal em pacientes com deficiência cognitiva leve e controles cognitivos saudáveis

Abstract Background Given that, up to date, there is no effective strategy to treat dementia, a timely start of interventions in a prodromal stage such as mild cognitive impairment (MCI) is considered an important option to lower the overall societal burden. Although autonomic functions have been related to cognitive performance, both aspects have rarely been studied simultaneously in MCI. Objective The aim of the present study was to investigate cardiac autonomic control in older adults with and without MCI. Methods Cardiac autonomic control was assessed by means of heart rate variability (HRV) at resting state and during cognitive tasks in 22 older adults with MCI and 29 healthy controls (HCs). Resting HRV measurement was performed for 5 minutes during a sitting position. Afterwards, participants performed three PC-based tasks to probe performance in executive functions and language abilities (i.e., Stroop, N-back, and a verbal fluency task). Results Participants with MCI showed a significant reduction of HRV in the frequency-domain (high frequency power) and nonlinear indices (SD2, D2, and DFA1) during resting state compared to HCs. Older individuals with MCI exhibited decreases in RMSSD and increases in DFA1 from resting state to Stroop and N-back tasks, reflecting strong vagal withdrawal, while this parameter remained stable in HCs. Conclusion The results support the presence of autonomic dysfunction at the early stage of cognitive impairment. Heart rate variability could help in the prediction of cognitive decline as a noninvasive biomarker or as a tool to monitor the effectiveness of therapy and prevention of neurodegenerative diseases.

Resumo Antecedentes Como não existe até o momento uma estratégia eficaz para tratar a demência de comprometimento cognitivo leve (MCI, na sigla em inglês), as intervenções em um estágio prodrômico são consideradas uma opção. Embora as funções autonômicas tenham sido relacionadas ao desempenho cognitivo, ambos os aspectos raramente foram estudados simultaneamente no MCI. Objetivo Investigar o controle autonômico cardíaco em idosos com e sem MCI. Métodos O controle autonômico cardíaco foi avaliado por meio da variabilidade da frequência cardíaca (HRV, na sigla em inglês) em repouso e durante tarefas cognitivas, em 22 idosos com MCI e 29 controles saudáveis (HCs, na sigla em inglês). A medida da HRV de repouso foi realizada por 5 minutos na posição sentada. Os participantes realizaram três tarefas executadas em computador para testar o desempenho em funções executivas e habilidades de linguagem (o teste de cores e palavras - Stroop, Tarefa N-back auditiva e uma tarefa de fluência verbal). Resultados Em pacientes com MCI, observou-se uma redução significativa da HRV no domínio da frequência (potência de alta frequência) e índices não lineares (SD2, D2 e DFA1) durante o estado de repouso em comparação com os HCs. Indivíduos mais velhos com MCI exibiram diminuições em RMSSD e aumentos em DFA1 do estado de repouso para Stroop e tarefas N-back, refletindo forte recessão vagal, enquanto este parâmetro permaneceu estável em HC. Conclusão Observou-se disfunção autonômica na fase inicial da neurodegeneração. A HRV pode ajudar na previsão do declínio cognitivo, como um biomarcador não invasivo, ou como uma ferramenta para monitorar a eficácia da terapia e prevenção de doenças neurodegenerativas.

Voltage Dependent Anion Channel 1 Mediated Inflammation and Obstructive Sleep Apnea Syndrome / 中山大学学报(医学科学版)

VDAC1（voltage dependent anion channel 1）is an important channel protein on the outer mitochondrial outer membrane， which regulates mitophagy， participates in the regulation of inflammatory cytokines and the activation of the inflammasome， hence being crucial to the inflammatory response. Patients with obstructive sleep apnea syndrome （OSAS） suffer neuroinflammation due to intermittent hypoxia and increased oxidative stress， leading to chronic damage and neuronal cell apoptosis， and eventually develop cognitive impairment. Since OSAS patients' cognitive impairment is significantly influenced by inflammation， and VDAC1 regulates the activation of the inflammasome， the relationship between OSAS and VDAC1， mitophagy， as well as inflammation are reviewed here. We hope that this study can provide a new breakthrough in mitophagy and inflammation in patients with cognitive dysfunction caused by OSAS.

Spatial distribution of cognitive dysfunction and its risk factors in Chinese population aged 45 years and above / 南方医科大学学报

OBJECTIVE@#To analyze the spatial distribution of the prevalence of cognitive dysfunction and its risk factors in Chinese population aged 45 years and above to provide evidence for formulating regional prevention and control strategies.@*METHODS@#The study subjects with complete cognitive function data were selected from the follow-up data of the China Health and Retirement Longitudinal Study (CHARLS) Phase IV. ArcGis 10.4 software was used for spatial analysis of the prevalence of cognitive dysfunction in the population aged 45 years and above for each province based on the geographic information system (GIS) technology.@*RESULTS@#In 2018, the overall prevalence of cognitive dysfunction was 33.59% (5951/17716) in individuals aged 45 and above in China. Global spatial autocorrelation analysis indicated a spatial clustering and a positive autocorrelation (P < 0.001) of the prevalence of cognitive dysfunction in the study subjects, with a Moran's I value of 0.333085. The results of local spatial autocorrelation analysis showed that the southwestern region of China was the main aggregation area of patients with cognitive dysfunction. Geographically weighted regression analysis suggested that a male gender, an advanced age, and illiteracy were the major risk factors for cognitive dysfunction (P < 0.05). These 3 risk factors showed a spatial distribution heterogeneity with greater impact in the northern, western, and northwestern regions of China, respectively.@*CONCLUSION@#The prevalence of cognitive dysfunction is relatively high in individuals aged 45 years and above in China. A male gender, an advanced age, and illiteracy are the major risk factors for cognitive dysfunction and show different spatial distribution patterns, with the northern, western and northwestern regions of China as the key areas for prevention and control, where the prevention and control measures should be designed based on local conditions.