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It is well-established that light therapy can alleviate cognitive impairment, and ambient illumination (AI) can quantify the amount of exposure to light. However, the relationship between AI and cognitive impairment has been largely understudied. Objectives. We aimed to examine the cross-sectional associations between AI and impaired cognition using data from the National Health and Nutrition Examination Survey (NHANES) (2011-2013) database. Methods. The correlation between AI and cognitive impairment was analyzed using multivariate logistic regression models. Nonlinear correlations were explored using curve fitting. Results. Multivariate logistic regression yielded an OR of 0.872 (95% CI 0.699, 1.088) for the association between AI and cognitive impairment after adjusting for covariates. Smooth curve fitting showed that the correlation was nonlinear, with an inflection point at 1.22. Conclusions. These results suggested that the level of AI may be linked to cognitive impairment. We found a nonlinear relationship of AI with cognitive impairment.
Assuntos
Transtornos Cognitivos , Disfunção Cognitiva , Humanos , Transtornos Cognitivos/diagnóstico , Inquéritos Nutricionais , Estudos Transversais , Iluminação , Disfunção Cognitiva/epidemiologia , CogniçãoRESUMO
OBJECTIVES: The aim of this study is to investigate the effects that the Al on blood pressure and the effect of hypertension in aluminum-induced cognitive impairment in electrolytic aluminum worker. METHODS: The study was conducted 392 male aluminum electrolytic workers in an aluminum plant of China. The concentration of alumina dust in the air of the electrolytic aluminum workshop is 1.07 mg/m3-2.13 mg/m3. According to the Permissible concentration-Time Weighted Average of alumina dust is 4 mg/m3, which does not exceed the standard. The blood pressure of the workers was measured. The plasma aluminum concentration of workers was determined by ICP-MS (Inductively Coupled Plasma Mass Spectrometry). Cognitive functions were measured using MMSE (Mini-Mental State Examination), VFT (Verbal Fluency Test), ATIME (Average Reaction Time), FOM (Fuld Object Memory Evaluation), DST (Digit Span Test), CDT (Clock Drawing Test) scales. Modified Poisson regression was used to analyze the risk of hypertension and cognitive impairment with different plasma aluminum concentrations. Generalized linear regression model was used to analyze the relationship between aluminum and cognitive function, blood pressure and cognitive function. Causal Mediation Analysis was used to analyze the mediation effect of blood press in aluminum-induced cognitive impairment. RESULTS: Plasma aluminum appeared to be a risk factor for hypertension (PR (prevalence ratio) = 1.630, 95 %-CI (confidence interval): 1.103-2.407), systolic blood pressure (PR = 1.578, 95 %-CI: 1.038-2.399) and diastolic blood pressure (PR = 1.842, 95 %-CI: 1.153-2.944). And plasma aluminum increased by e-fold, the scores of MMSE and VFT decreased by 0.630 and 2.231 units respectively and the time of ATIME increased by 0.029 units. In addition, generalized linear regression model showed that blood press was negatively correlated with the scores of MMSE and VFT. Finally, causal Mediation Analysis showed that hypertension was a part of the mediating factors of aluminum-induced decline in MMSE score, and the mediating effects was 16.300 % (7.100 %, 33.200 %). In addition, hypertension was a part of the mediating factors of aluminum-induced decline in VFT score, and the mediating effects was 9.400 % (2.600 %, 29.000 %) CONCLUSION: Occupational aluminum exposure increases the risk of hypertension and cognitive impairment. And hypertension may be a mediating factor of cognitive impairment caused by aluminum exposure.
Assuntos
Transtornos Cognitivos , Disfunção Cognitiva , Hipertensão , Alumínio/toxicidade , Óxido de Alumínio , Pressão Sanguínea , Cognição , Transtornos Cognitivos/induzido quimicamente , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Disfunção Cognitiva/induzido quimicamente , Disfunção Cognitiva/diagnóstico , Poeira , Humanos , Hipertensão/induzido quimicamente , Hipertensão/complicações , MasculinoRESUMO
Cognitive function decline is strictly related to age, resulting in the loss of the ability to perform daily behaviors and is a fundamental clinical neurodegeneration symptom. It has been proven that an adequate diet, comprehensive nutrition, and a healthy lifestyle may significantly inhibit neurodegenerative processes, improving cognitive functions. Therefore, intensive research has been conducted on cognitive-enhancing treatment for many years, especially with substances of natural origin. There are several intervention programs aimed at improving cognitive functions in elderly adults. Cognitive functions depend on body weight, food consumed daily, the quality of the intestinal microflora, and the supplements used. The effectiveness in the prevention of dementia is particularly high before the onset of the first symptoms. The impact of diet and nutrition on age-associated cognitive decline is becoming a growing field as a vital factor that may be easily modified, and the effects may be observed on an ongoing basis. The paper presents a review of the latest preclinical and clinical studies on the influence of natural antioxidants on cognitive functions, with particular emphasis on neurodegenerative diseases. Nevertheless, despite the promising research results in animal models, the clinical application of natural compounds will only be possible after solving a few challenges.
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Envelhecimento , Antioxidantes/uso terapêutico , Produtos Biológicos/uso terapêutico , Transtornos Cognitivos/tratamento farmacológico , Transtornos Cognitivos/etiologia , Doenças Neurodegenerativas/complicações , Animais , Antioxidantes/farmacologia , Produtos Biológicos/farmacologia , Ensaios Clínicos como Assunto , Cognição/efeitos dos fármacos , Transtornos Cognitivos/diagnóstico , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/etiologia , Suplementos Nutricionais , Avaliação Pré-Clínica de Medicamentos , Humanos , Doenças Neurodegenerativas/tratamento farmacológico , Doenças Neurodegenerativas/etiologia , Resultado do TratamentoRESUMO
Cognitive symptoms occur in almost all patients with brain tumors at varying points in the disease course. Deficits in neurocognitive function may be caused by the tumor itself, treatment (surgery, radiation, or chemotherapy), or other complicating factors (e.g., seizures, fatigue, mood disturbance) and can have a profound effect on functional independence and quality of life. Assessment of neurocognitive function is an important part of comprehensive care of patients with brain tumors. In the neuro-oncology clinic, assessment may include cognitive screening tools and inquiry into subjective cognitive function. Neuropsychological assessment is an important adjunct to identify cognitive symptoms and can be used as an opportunity to intervene through transformative feedback and treatment planning. Preventative measures can be taken to reduce cognitive side effects of treatment, such as awake craniotomies with intraoperative mapping during neurosurgery or prophylactic measures during radiation therapy (e.g., hippocampal avoidance, neuroprotectant treatment with memantine). Rehabilitative therapies, including cognitive rehabilitation and computerized cognitive exercise, are options for managing cognitive problems in an individualized manner. Pharmacotherapy, including use of stimulant medications and acetylcholinesterase inhibitors, has shown benefits for patients with brain tumors when tailored to an individual's cognitive profile. Identification and management of co-occurring issues, such as sleep disturbance, fatigue, and depression, can also improve neurocognitive function. There are promising therapies under development that may provide new options for treatment in the future. Integrating careful assessment and treatment of cognition throughout the disease course for patients with brain tumors can improve functional outcomes and quality of life.
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Neoplasias Encefálicas , Transtornos Cognitivos , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/terapia , Cognição , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/terapia , Fadiga/diagnóstico , Fadiga/epidemiologia , Fadiga/etiologia , Humanos , Qualidade de VidaRESUMO
Although the intervention effectiveness of cognitive control is disputed, some methods, such as single-task training, integrated training, meditation, aerobic exercise, and transcranial stimulation, have been reported to improve cognitive control. This review of recent advances from evaluation to prediction of cognitive control interventions suggests that brain modularity may be an important candidate marker for informing clinical decisions regarding suitable interventions. The intervention effect of cognitive control has been evaluated by behavioral performance, transfer effect, brain structure and function, and brain networks. Brain modularity can predict the benefits of cognitive control interventions based on individual differences and is independent of intervention method, group, age, initial cognitive ability, and education level. The prediction of cognitive control intervention based on brain modularity should extend to task states, combine function and structure networks, and assign different weights to subnetwork modularity.
Assuntos
Encéfalo/fisiologia , Transtornos Cognitivos , Função Executiva/fisiologia , Plasticidade Neuronal , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/terapia , Exercício Físico/psicologia , Humanos , Individualidade , Meditação , Vias Neurais/fisiologia , Estimulação Transcraniana por Corrente ContínuaRESUMO
BACKGROUND: The purpose of this study is to determine whether there is a relationship between cognitive impairment among Medicare patients and hospital readmissions. Although there has been research on cognitive impairment and readmissions, seldom action has been done in regard to economic costs with hospitals. The Affordable Care Act (ACA) established the Hospital Readmission Reduction Program in 2012. Hospitals may not be fully reimbursed for Medicare patient readmissions within 30 days (). STUDY DESIGN: An ethnographic approach was utilized with purposive sampling.This was a nonrandomized purposive sampling intervention study using data from Epic health systems database. METHODS: The intervention spanned over 5 months and the MoCA (Montreal Cognitive Assessment) intervention was conducted in the hospital in a 3-phase study. The purpose of the study was for quality improvement and to detect cognitive impairment among Medicare readmitted patients. RESULTS: The result shows cognitive impairment is prevalent among the Medicare population. Seventy-one (61%) had evidence of cognitive impairment (i.e., obtained a score below 25). The mean MoCA score for the 71 patients identified as having evidence of cognitive impairment was 17.84 (SD, ±5.06; range, 5-24). MoCA is useful in the acute care setting for identifying patients who are at increased risk for readmission. A randomly assigned controlled clinical trial test is warranted to further validate the association between cognitive impairment and readmissions. IMPLICATIONS FOR CASE MANAGEMENT: The ACA aims to improve case management by improving effective outcomes for individuals, care coordination among hospital professionals, economic efficiency, cost-effectiveness, and the collaborative process that services the patient. Hospitals across the country are implementing polices that adhere to patient-centered care. Before the ACA was passed, health care services were value metric. The ACA regulates hospitals toward holistic care or quality metrics. Case management will be critical, as hospitals look toward innovative methods to evaluate their patients.
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Transtornos Cognitivos/diagnóstico , Readmissão do Paciente , Humanos , Medicare , Estados UnidosRESUMO
Cardiovascular clinicians tend to pay little attention to issues related to cognition, and yet those caring for older adults will encounter a variety of conditions that may lead to cognitive impairment. Most commonly, these include cardiovascular disease-specific conditions such as cerebrovascular disease or heart failure, but may also include neurodegenerative conditions, mood disorders, medication side effects and polypharmacy, and nutritional deficiencies and metabolic derangements among others. This review presents evidence supporting the importance of assessing cognitive status in older adults with cardiovascular disease, and suggests a practical approach to assessment and management of cognitive impairment in this population when it is found. Special attention is paid to the importance of collaboration between cardiovascular and geriatric specialists, and the value it may bring to patients.
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Doenças Cardiovasculares/terapia , Transtornos Cognitivos/diagnóstico , Cognição , Envelhecimento Cognitivo/psicologia , Avaliação Geriátrica , Testes Neuropsicológicos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cardiologistas , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/psicologia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/psicologia , Transtornos Cognitivos/terapia , Prestação Integrada de Cuidados de Saúde , Geriatras , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Equipe de Assistência ao Paciente , Cooperação do Paciente , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , AutocuidadoRESUMO
BACKGROUND: Cognitive impairment (CI) is frequent in patients with multiple sclerosis (PwMS) and could negatively affect family social and vocational activities. Detecting CI is clinically relevant, so the emerging question is the strategy for assessing cognition in MS. OBJECTIVE: An update on cognitive assessment in PwMS with use of standard neuropsychological (NP) tests and ecological tools. RESULTS: The minimal cognitive assessment in MS should include at least NP tests assessing information processing speed (IPS) and verbal and visuospatial episodic memory. The IPS could be easily and quickly evaluated with symbol digit substitution tests by using paper for the oral version of the Symbol Digit Modalities Test or a laptop for the Computerised Speed Cognitive Test. The comprehensive NP battery must be performed by a qualified neuropsychologist to adequately characterize the extent and severity of CI in PwMS. The quiet and controlled environment used for this standardized assessment could be a limitation for generalizing the results because it does not reflect real daily life conditions. Thus, this context could decrease the ability to detect some cognitive deficits that could occur only in more complex situations. Thus, ecological evaluation seems a complementary and promising approach for detecting cognitive abnormalities in daily activities. CONCLUSION: Recent efforts have been made to detect and characterize cognitive deficits in PwMS. Some IPS and episodic memory NP tests have been validated in MS and should be proposed to patients in the clinical setting. Besides NP tests, ecological tools are becoming important for detecting cognitive dysfunction in everyday-like conditions. Further research is needed to validate relevant tools for monitoring cognition in MS and the ability to detect clinically meaningful change in longitudinal studies.
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Transtornos Cognitivos/diagnóstico , Esclerose Múltipla/psicologia , Testes Neuropsicológicos , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/reabilitação , Transtornos Cognitivos/terapia , Terapia Cognitivo-Comportamental , Depressão/etiologia , Depressão/psicologia , Terapia por Exercício , Humanos , Atenção Plena , Esclerose Múltipla/complicações , Qualidade de Vida , AutoimagemRESUMO
AIM: Type 2 diabetes increases the risk of cognitive decline which adversely impacts self-management of the disease. Evidence also supports a relationship between low serum 25(OH)D levels and poor cognition. The purpose of this trial was to assess vitamin D supplementation on cognitive executive functioning in persons living with type 2 diabetes. METHODS: This was a double-blinded RCT where participants were randomized to receive either weekly vitamin D3 supplementation (50,000 IUs) or a matching comparator (5,000 IUs) for three months. The primary outcome was a battery of neuropsychological tests. Serum 25(OH)D was measured by liquid chromatography/tandem mass spectrometry. Repeated assessments of cognitive measures were collected over 12 weeks using alternative testing forms to minimize practice effects. RESULTS: Thirty participants were randomized to either the low-dose allocation (n = 15) or the high-dose allocation (n = 15). Most participants were female (83%) and identified as Black (57%). For all cognition measures, there was no statistically significant finding between participants who received high-dose vitamin D supplementation and those who received low-dose supplementation. However, when assessing cognitive function in both groups over time, minimal improvement on the Symbol-Digits, the Stroop Interference Test, and the Trail Making Test Part B was observed. CONCLUSIONS: To our knowledge, this is the first randomized control trial to examine the effects of vitamin D supplementation on cognitive function in people with type 2 diabetes. However, no significant differences in cognitive outcomes between participants who received high-dose therapy and those who received low dose were found.
Assuntos
Colecalciferol/administração & dosagem , Transtornos Cognitivos/tratamento farmacológico , Cognição/efeitos dos fármacos , Diabetes Mellitus Tipo 2/complicações , Deficiência de Vitamina D/tratamento farmacológico , Idoso , Biomarcadores/sangue , Chicago , Colecalciferol/efeitos adversos , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnósticoRESUMO
Vitamin B12 and folic acid deficiencies are particularly frequent conditions in older people. Since these metabolic disorders represent relevant dyscognitive factors, the assessment of vitamin B12 and folic acid levels is essential in the diagnostic approach of cognitive disorders, such as mild cognitive impairment and dementia in an outpatient memory clinic. This article summarizes the relevant diagnostic and therapeutic aspects of vitamin B12 and folic acid deficiencies and their effects on cognition. The literature review is supplemented by a data analysis of a naturalistic cohort of 250 patients from this outpatient memory clinic.
Assuntos
Transtornos Cognitivos , Deficiência de Ácido Fólico/psicologia , Ácido Fólico , Deficiência de Vitamina B 12/psicologia , Vitamina B 12 , Idoso , Idoso de 80 Anos ou mais , Cognição , Transtornos Cognitivos/sangue , Transtornos Cognitivos/diagnóstico , Análise de Dados , Ácido Fólico/sangue , Humanos , Pacientes Ambulatoriais , Universidades , Vitamina B 12/sangueRESUMO
OBJECTIVE: To systematically investigate whether cognitive "insomnia" processes are implicated in adolescent Delayed Sleep-Wake Phase Disorder (DSWPD) and to examine whether these processes are responsive to chronobiological treatment. METHOD: Sixty-three adolescents (M = 15.8 ± 2.2 years, 63.5% f) diagnosed with DSWPD and 40 good sleeping adolescents (M = 15.9 ± 2.4 years, 75% f) completed baseline measures of sleep, daytime functioning and cognitive "insomnia" processes (i.e., repetitive negative thinking, physiological hyperarousal, distress, sleep-related attention and monitoring, sleep misperception). Sixty DSWPD adolescents (M = 15.9 ± 2.2 y, 63% f) entered a treatment trial and received 3 weeks of light therapy. Sleep, daytime functioning, and insomnia were measured again post-treatment and at 3-month follow-up. RESULTS: Adolescents with DSWPD had significantly later sleep timing (d = 0.99-1.50), longer sleep latency (d = 1.14), and shorter total sleep time (d = 0.85) on school nights, compared with the good sleeping adolescents. There was evidence of cognitive "insomnia" symptoms, with the DSWPD group reporting more repetitive negative thinking (d = 0.70-1.02), trait hyperarousal (d = 0.55), distress (d = 2.19), sleep associated monitoring (d = 0.76), and sleep onset misperception (d = 1.29). Across treatment and follow-up, adolescents with DSWPD reported advanced sleep timing (d = 0.54-0.62), reduced sleep latency (d = 0.53), increased total sleep time (d = 0.49), and improved daytime functioning (d = 0.46-1.00). Repetitive negative thinking (d = 0.64-0.96), physiological arousal (d = 0.69), distress (d = 0.87), and sleep onset misperception (d = 0.37) also showed improvement. CONCLUSIONS: Cognitive "insomnia" processes may be implicated in the development and maintenance of DSWPD in adolescents. Many of these processes are amendable to chronobiological treatment; however, residual symptoms may place adolescents at risk of poor treatment outcome or relapse. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Transtornos Cognitivos/terapia , Transtornos do Sono do Ritmo Circadiano/terapia , Distúrbios do Início e da Manutenção do Sono/terapia , Cronoterapia de Fase do Sono , Adolescente , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino , Pessimismo , Transtornos do Sono do Ritmo Circadiano/diagnóstico , Transtornos do Sono do Ritmo Circadiano/psicologia , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/psicologia , Vigília , Adulto JovemRESUMO
PURPOSE: Chemotherapy-related cognitive impairment can occur in cancer survivors after treatment, especially those patients who have undergone chemotherapy for breast cancer. The frequency and to what extent such toxicity develops in colorectal cancer (CRC) survivors is unknown. The present prospective study evaluated the effects of adjuvant chemotherapy on the cognitive performance of patients with localized CRC compared with a control group who had not undergone chemotherapy. PATIENTS AND METHODS: Consecutive patients with localized stage II and III CRC completed neuropsychological assessments, self-reported cognitive complaint questionnaires, and depressive symptom evaluations before starting fluoropyrimidine-based adjuvant chemotherapy and after 12 months. Blood was collected for apolipoprotein E genotyping. Diffusion tensor imaging data were acquired from a subset of participants at both evaluation points. RESULTS: From December 2012 to December 2014, 137 patients were approached and 85 were included. Of these 85 patients, 49 had undergone chemotherapy and 26 had not, in accordance with the standard recommendations for adjuvant therapy for CRC. The mean age was 62.5 ± 9.4 years, 60% were men, and the mean educational attainment was 7.6 ± 3.7 years. No difference was found in the global composite score (P = .38), attention (P = .84), or memory (P = .97) between the 2 groups during the follow-up period (mean ± standard deviation, 375 ± 29 days). However, a statistically significant difference was found for executive function after adjustment for age, sex, education, and depressive symptoms at baseline (ß -1.80; 95% confidence interval, -3.50 to -0.11; P = .04), suggesting worse performance for the chemotherapy group. For the 32 patients who had undergone magnetic resonance imaging, tract-based spatial statistics did not show voxelwise significant differences in structural brain connectivity at baseline or during follow-up. Apolipoprotein E polymorphisms were not predictive of cognitive dysfunction. CONCLUSION: Patients with CRC who received adjuvant 5-fluorouracil with or without oxaliplatin presented with a decline in executive function after 12 months compared with patients with localized disease who had not received chemotherapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transtornos Cognitivos/tratamento farmacológico , Neoplasias Colorretais/complicações , Idoso , Estudos de Casos e Controles , Quimioterapia Adjuvante , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Neoplasias Colorretais/patologia , Imagem de Tensor de Difusão , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Humanos , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Oxaliplatina/administração & dosagem , Prognóstico , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Covert vascular disease of the brain manifests as infarcts, white matter hyperintensities, and microbleeds on MRI. Their cumulative effect is often a decline in cognition, motor impairment, and psychiatric disorders. Preventive therapies for covert brain ischemia have not been established but represent a huge unmet clinical need. AIMS: The MRI substudy examines the effects of the antithrombotic regimens in COMPASS on incident covert brain infarcts (the primary outcome), white matter hyperintensities, and cognitive and functional status in a sample of consenting COMPASS participants without contraindications to MRI. METHODS: COMPASS is a randomized superiority trial testing rivaroxaban 2.5 mg bid plus acetylsalicylic acid 100 mg and rivaroxaban 5 mg bid against acetylsalicylic acid 100 mg per day for the combined endpoint of MI, stroke, and cardiovascular death in individuals with stable coronary artery disease or peripheral artery disease. T1-weighted, T2-weighted, T2*-weighted, and FLAIR images were obtained close to randomization and near the termination of assigned antithrombotic therapy; biomarker and genetic samples at randomization and one month, and cognitive and functional assessment at randomization, after two years and at the end of study. RESULTS: Between March 2013 and May 2016, 1905 participants were recruited from 86 centers in 16 countries. Of these participants, 1760 underwent baseline MRI scans that were deemed technically adequate for interpretation. The mean age at entry of participants with interpretable MRI was 71 years and 23.5% were women. Coronary artery disease was present in 90.4% and 28.1% had peripheral artery disease. Brain infarcts were present in 34.8%, 29.3% had cerebral microbleeds, and 93.0% had white matter hyperintensities. The median Montreal Cognitive Assessment score was 26 (interquartile range 23-28). CONCLUSIONS: The COMPASS MRI substudy will examine the effect of the antithrombotic interventions on MRI-determined covert brain infarcts and cognition. Demonstration of a therapeutic effect of the antithrombotic regimens on brain infarcts would have implications for prevention of cognitive decline and provide insight into the pathogenesis of vascular cognitive decline.
Assuntos
Anticoagulantes/uso terapêutico , Infarto Encefálico/tratamento farmacológico , Isquemia Encefálica/tratamento farmacológico , Encéfalo/patologia , Transtornos Cognitivos/tratamento farmacológico , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Idoso , Infarto Encefálico/diagnóstico , Isquemia Encefálica/diagnóstico , Cognição , Transtornos Cognitivos/diagnóstico , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico , Resultado do TratamentoRESUMO
AIM: The present study aimed to: (i) examine the reliability and validity of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items for classifying patients to the appropriate categories for glycemic targets in older patients; and (ii) develop a short version of the tool and examine its reliability and validity. METHODS: A total of 410 older individuals were recruited for this multicenter cross-sectional study. We classified them into three categories used for determining the glycemic target in older patients in Japan based on cognitive functions and activities of daily living. Exploratory factor analyses were used to select the eight items of the shorter version. The reliability and validity of the assessment tools were assessed using Cronbach's alpha coefficients and receiver operating characteristic analyses, respectively. RESULTS: The Dementia Assessment Sheet for Community-based Integrated Care System 21-items had three latent factors: cognitive function, instrumental activities of daily living and basic activities of daily living. The Dementia Assessment Sheet for Community-based Integrated Care System 8-items was developed based on each factor load quantity and was confirmed to have a strong correlation with the original version (r = 0.965, P < 0.001). Both tools significantly discriminated older adults belonging to category I from those belonging to category II or III, and category III from category I or II. CONCLUSIONS: Both tools had sufficient internal consistency and validity to classify older patients into the categories for determining the glycemic target in this population based on cognitive and daily functions. Geriatr Gerontol Int 2018; 18: 1458-1462.
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Atividades Cotidianas , Transtornos Cognitivos/diagnóstico , Prestação Integrada de Cuidados de Saúde , Demência/diagnóstico , Avaliação Geriátrica/métodos , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/epidemiologia , Serviços de Saúde Comunitária , Estudos Transversais , Demência/epidemiologia , Feminino , Humanos , Japão , Modelos Logísticos , Masculino , Análise Multivariada , Testes Neuropsicológicos , Psicometria , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
Deficiencies in theory of mind (ToM) are common in psychosis and may largely explain impaired social functioning. Currently, it is unclear whether impairments in ToM are explained by the more general cognitive deficits related to psychosis or whether ToM is impaired in psychosis independently of other cognitive deficits. This study examined ToM using the Hinting Task in young adults (nâ¯=â¯66) with first-episode psychosis and matched controls (nâ¯=â¯62). The participants were administered a broad neuropsychological assessment. Participants with psychosis performed worse than controls on the Hinting Task. However, 75% of the variance between the groups was explained by general cognitive deficits, especially impaired processing speed and episodic memory. Hinting Task performance of the best functioning patient group did not differ from that of the control group. When the psychosis group was divided according to diagnosis, the Hinting Task difference between individuals with schizophrenia and controls remained significant even when general cognitive performance was controlled for, suggesting specific verbal ToM deficits in schizophrenia. In contrast, those with other psychotic disorders did not differ from controls. Our results suggest that ToM deficits can be seen in early phases of psychotic disorders, schizophrenia in particular, and are partly independent of other cognitive functions.
Assuntos
Desempenho Psicomotor , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Psicologia do Esquizofrênico , Sugestão , Teoria da Mente , Adolescente , Adulto , Cognição/fisiologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Transtornos Cognitivos/terapia , Feminino , Seguimentos , Humanos , Masculino , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Desempenho Psicomotor/fisiologia , Transtornos Psicóticos/terapia , Esquizofrenia/diagnóstico , Esquizofrenia/terapia , Teoria da Mente/fisiologia , Adulto JovemRESUMO
OBJECTIVES: Bipolar disorder is a complex illness often requiring combinations of therapies to successfully treat symptoms. In recent years, there have been significant advancements in a number of therapies for bipolar disorder. It is therefore timely to provide an overview of current adjunctive therapeutic options to help treating clinicians to inform their patients and work towards optimal outcomes. METHODS: Publications were identified from PubMed searches on bipolar disorder and pharmacotherapy, nutraceuticals, hormone therapy, psychoeducation, interpersonal and social rhythm therapy, cognitive remediation, mindfulness, e-Health and brain stimulation techniques. Relevant articles in these areas were selected for further review. This paper provides a narrative review of adjunctive treatment options and is not a systematic review of the literature. RESULTS: A number of pharmacotherapeutic, psychological and neuromodulation treatment options are available. These have varying efficacy but all have shown benefit to people with bipolar disorder. Due to the complex nature of treating the disorder, combination treatments are often required. Adjunctive treatments to traditional pharmacological and psychological therapies are proving useful in closing the gap between initial symptom remission and full functional recovery. CONCLUSIONS: Given that response to monotherapy is often inadequate, combination regimens for bipolar disorder are typical. Correspondingly, psychiatric research is working towards a better understanding of the disorder's underlying biology. Therefore, treatment options are changing and adjunctive therapies are being increasingly recognized as providing significant tools to improve patient outcomes. Towards this end, this paper provides an overview of novel treatments that may improve clinical outcomes for people with bipolar disorder.
Assuntos
Transtorno Bipolar/terapia , Terapia Combinada/métodos , Adulto , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Transtornos Cognitivos/terapia , Remediação Cognitiva/métodos , Humanos , Masculino , Psicoterapia/métodos , Psicotrópicos/uso terapêutico , Terapia Assistida por Computador , Estimulação Magnética Transcraniana , Resultado do TratamentoRESUMO
Children and adolescents are affected in different ways by HIV/AIDS. Neurocognitive deficits are one of the most significant long term effects on HIV infected children and adolescents. Several factors are thought to influence cognitive outcomes and this include immune status, Highly Active Antiretroviral Therapy (HAART), education and social support. The aim of the study was to assess the neurocognitive function of HIV infected children and adolescents and correlate it with psychosocial factors. A cross sectional study was carried out involving a sample of 90 children living with HIV between 8 and 15 years (M = 11.38, SD = 2.06) attending Comprehensive Care Clinic (CCC) at Kenyatta National Hospital (KNH). Samples were selected by using purposive sample technique. Kaufman Assessment Battery for Children-Second Edition was used to assess cognitive function and psychosocial issues were assessed using HEADS-ED. Data was analyzed using SPSS v23 and independent T-tests, Pearson's correlation and linear regression were used. The prevalence of neurocognitive deficits among HIV positive children attending CCC at KNH was 60% with neurocognitive performance of 54 children being at least 2SD below the mean based on the KABC-II scores. There was no significant correlation between mental processing index and CD4 count (Pearson's rho = -0.01, p = 0.39). There was no significant association between Mental Processing Index and viral load (p = 0.056) and early ARV initiation (0.27). Using the HEADS-ED, risks factors related to education (ß = -5.67, p = 0.02) and activities and peer support (ß = -9.1, p = 0.002) were significantly associated with poor neurocognitive performance. Neurocognitive deficits are prevalent among HIV positive children attending CCC-KNH. This extent of the deficits was not associated with low CD4 count, high viral load or early initiation in HIV care. However, poor school performance and problem with peers was associated with poor neurocognitive performance.
Assuntos
Fracasso Acadêmico/psicologia , Transtornos Cognitivos/virologia , Assistência Integral à Saúde , Infecções por HIV/psicologia , Relações Interpessoais , Adolescente , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Criança , Cognição , Transtornos Cognitivos/diagnóstico , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Humanos , Quênia , Masculino , Processos Mentais , Testes Neuropsicológicos , Ambulatório Hospitalar , Grupo Associado , Fatores de Risco , Carga ViralRESUMO
AIM: Difficulties in reading comprehension can arise from either word reading or listening comprehension difficulties, or a combination of the two. We sought to determine whether children with rolandic epilepsy had poor reading comprehension relative to typically developing comparison children, and whether such difficulties were associated with word reading and/or general language comprehension difficulties. METHOD: In this cross-sectional study, children with rolandic epilepsy (n=25; 16 males, 9 females; mean age 9y 1mo, SD 1y 7mo) and a comparison group (n=39; 25 males, 14 females; mean age 9y 1mo, SD 1y 3mo) completed assessments of reading comprehension, listening comprehension, word/non-word reading, speech articulation, and Non-verbal IQ. RESULTS: Reading comprehension and word reading were worse in children with rolandic epilepsy (F1,61 =6.89, p=0.011, ηp2=0.10 and F1,61 =6.84, p=0.011, ηp2=0.10 respectively), with listening comprehension being marginal (F1,61 =3.81, p=0.055, ηp2=0.06). Word reading and listening comprehension made large and independent contributions to reading comprehension, explaining 70% of the variance. INTERPRETATION: Children with rolandic epilepsy may be at risk of reading comprehension difficulties. Thorough assessment of individual children is required to ascertain whether the difficulties lie with decoding text, or with general comprehension skills, or both. WHAT THIS PAPER ADDS: Children with rolandic epilepsy may be at risk of poor reading comprehension. This was related to poor word reading, poor listening comprehension, or both. Reading comprehension interventions should be tailored to the profile of difficulties.
Assuntos
Transtornos Cognitivos/etiologia , Compreensão/fisiologia , Dislexia/etiologia , Epilepsia Rolândica/complicações , Epilepsia Rolândica/psicologia , Estimulação Acústica , Análise de Variância , Criança , Transtornos Cognitivos/diagnóstico , Estudos Transversais , Dislexia/diagnóstico , Feminino , Humanos , Testes de Linguagem , Masculino , Estudos RetrospectivosRESUMO
The main goal of this study was to produce adjusted normative data for the Portuguese population on the Paced Auditory Serial Addition Test (PASAT 3.0 s), the version used in the Brief Repeatable Battery of Neuropsychological Tests developed by the National Multiple Sclerosis Society. The study included 326 community-dwelling individuals (199 women and 127 men) aged between 20 and 70 (mean = 40.33, SD = 14.40), who had educational backgrounds ranging from 4 to 23 years of schooling (mean = 12.28, SD = 4.39). Age, gender and qualifications revealed differences in explaining their performance on the PASAT 3.0 s. Men had significantly better performance on the PASAT 3.0 s than women, even though this represents a small effect size r = 0.18. Demographically corrected normative data was developed and important information regarding performance on the PASAT 3.0 s test is provided. Results are discussed and presented in tables and a formula is presented for computing age, gender and education adjusted T-scores for performance on the PASAT 3.0 s. These results should be considered as useful reference values for clinicians and investigators when applying the PASAT 3.0 s to assess cognitive function like information processing speed in different pathologies.
Assuntos
Transtornos Cognitivos/diagnóstico , Testes Neuropsicológicos/normas , Estimulação Acústica , Adulto , Idoso , Atenção/fisiologia , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico , Portugal , Valores de Referência , Reprodutibilidade dos Testes , Adulto JovemRESUMO
BACKGROUND: Subjective cognitive decline (SCD) may be a very early symptom of Alzheimer's disease (AD) and may be associated with a cognitive decline in a cognitively normal population. The McNair and Kahn Scale was used to assess memory complaints in the GuidAge study. OBJECTIVE: Our objectives were to examine if the McNair and Kahn Scale can predict cognitive decline and to screen which (if any) of the question(s) of this scale would better predict this cognitive decline. METHODS: The GuidAge study was a phase III, multicenter, randomized, double blind, placebo-controlled study. Individuals aged 70 years and older, without cognitive impairment (Clinical Dementia Rate (CDRâ=â0)) at baseline who had spontaneously reported SCD were included in this study. The 20-item version of the McNair and Kahn Scale was used to assess SCD and a standardized neuropsychological assessment was used to assess the cognitive status. RESULTS: 1,307 patients with SCD and with CDRâ=â0 at baseline were included. During the 5 years of follow-up, 519 patients showed cognitive decline. Incidence of aggravation score of CDR was 13.40% person years (95% CI [12.24-14.56]). Results showed a significant relationship between the McNair and Kahn Scale score and decline in cognitive performance (HR 1.012; 95% CI [1.002-1.021]; pâ=â0.0156). Among the 20 items, 5 were statistically significant to predict cognitive decline after adjustment. CONCLUSION: SCD is a promising indicator of memory impairment. Our study found that using the McNair and Kahn scale can predict cognitive decline. A 5-item version of this scale could be used to screen patients in clinical practice and in clinical research.