Impact of COVID-19 infection on cognition and its association with neurological symptoms.

OBJECTIVE: To characterize the cognitive profile following COVID-19 infection and its possible association to clinical symptoms, emotional disturbance, biomarkers, and disease severity. METHODS: This was a single-center cross-sectional cohort study. Subjects between 20- and 60-year old with confirmed COVID-19 infection were included. Evaluation was performed between April 2020 and July 2021. Patients with previous cognitive impairment and other neurological or severe psychiatric disorders were excluded. Demographic and laboratory data were extracted from the medical records. RESULTS: Altogether 200 patients were included, 85 subjects were female (42.3%), and mean age was 49.12 years (SD: 7.84). Patients were classified into four groups: nonhospitalized (NH, n = 21), hospitalized without intensive care unit (ICU) nor oxygen therapy (HOSP, n = 42), hospitalized without ICU but with oxygen therapy (OXY, n = 107), and ICU (ICU, n = 31) patients. NH group was younger (p = .026). No significant differences were found in any test performed attending severity of illness (p > .05). A total of 55 patients reported subjective cognitive complaints (SCC). Subjects with neurological symptoms (NS) performed worse in trail making test B (p = .013), digits backwards (p = .006), letter&numbers (p = .002), symbol digit modalities test (p = .016), and Stroop color (p = .010) tests. CONCLUSIONS: OXY patients and females referred more SCC associated with symptoms of anxiety and depression. Objective cognitive performance was unrelated to SCC. No cognitive impairment was found regarding the severity of COVID-19 infection. Results suggest that NS such as headache, anosmia, and dysgeusia during infection were a risk factor for later cognitive deficits. Tests assessing attention, processing speed, and executive function were the most sensitive in detecting cognitive changes in these patients.

Ikos Test: New Tool for the Assessment of Semantic Knowledge in Early Alzheimer Disease.

BACKGROUND: Semantic memory (SM) constitutes a cognitive system that is seriously affected by Alzheimer's disease (AD). There are several tests for assessing SM, but a tool is needed to assess AD in the early stages of the illness. OBJECTIVE: The study aimed to create, validate, and normalize a new test to assess SM, called the Ikos test, for AD and early AD in clinical practice. METHODS: 62 healthy adults as a control group (CG), 62 AD, and 60 amnestic mild cognitive impairment (aMCI) subdivided into a group that progresses to AD, and another group that does not progress to AD were selected. The internal consistency (IC), the construct validity (CV), and reliability between raters and the test-retest were analyzed. We used the Bayesian approach to establish the accuracy of the diagnosis of the Ikos test in AD and early AD. RESULTS: IC showed a Kuder-Richardson index of r = 0.945. The CV between the Ikos test and Pyramids and Palm Trees; Intraclass Correlation Coefficient (ICC) index was 0.897. The Kappa index was between 0.865 and 0.912, and the ICC index was 0.873 for the test-retest reliability. The Area Under the Curve was 0.981, sensitivity (SE) was 0.95, and specificity (SP) was 0.96 in AD/CG. In contrast, in the MCI-AD/CG group, SE = 0.77 and SP = 0.80. CONCLUSION: The Ikos test accomplishes the criteria of validity and reliability with high correlation indexes. Therefore, it can be considered a valid, reliable, and easily applicable tool for SM assessment in diagnosing AD and the early stages of clinical disease.

In-Out-Test: A New Paradigm for Sorting the Wheat from the Chaff in Prodromal Alzheimer's Disease.

BACKGROUND: Assessment of hippocampal amnesia is helpful to distinguish between normal cognition and mild cognitive impairment (MCI), but not for identifying converters to dementia. Here biomarkers are useful but novel neuropsychological approaches are needed in their absence. The In-out-test assesses episodic memory using a new paradigm hypothesized to avoid reliance on executive function, which may compensate for damaged memory networks. OBJECTIVE: To assess the validity of the In-out-test in identifying prodromal Alzheimer's disease (PAD) in a clinical setting, by comparing this to the Free and Cued Selective Reminding Test (FCSRT) and cerebrospinal fluid biomarkers. METHODS: A cross-sectional study of 32 cognitively healthy, 32 MCI, and 30 progressive dementia subjects. All participants were given both the In-out-test and the FCSRT; 40 of them also received a lumbar puncture. RESULTS: Internal consistency was demonstrated using Cronbach Alpha (r = 0.81) and Inter-rater reliability with Kappa (k = 0.94). Intraclass correlation (ICC) for test-retest reliability: r = 0.57 (p = 0.57). ICC between the In-out-test and FCSRT r = 0.87 (p = 0.001). ICC between the In-out-test and Aß42 and P-tau/Aß42 for controls: 0.73 and 0.75, respectively; P-tau for MCI: 0.77 and total sample: 0.70; Aß42 for dementia: 0.71. All ICC measures between FCSRT and biomarkers were ≤0.264. AD diagnosis: In-out-test k = 0.71; FCSRT k = 0.49. PAD diagnosis (N = 35): In-out-test k = 0.69; FCSRT k = 0.44. CONCLUSIONS: The In-out-test detected prodromal AD with a higher degree of accuracy than a conventional hippocampal-based memory test. These results suggest that this new paradigm could be of value in clinical settings, predicting which patients with MCI will go on to develop AD.

Síndromes preamnésicos en la detección precoz de la enfermedad de alzheimer / No disponible

Las manifestaciones clínicas iniciales de la enfermedad de Alzheimer (EA) tienen un alto nivel de solapamiento con las características cognitivas propias del envejecimiento normal. Inicialmente suelen haber quejas subjetivas de memoria no evidenciadas en los tests neuropsicológicos y posteriormente un periodo denominado déficit cognitivo leve (DCL), en el cual se detectan cambios en el rendimiento neuropsicológico pero cuya intensidad no produce un impacto significativo en las actividades habituales ni las relaciones interpersonales del paciente. Actualmente el diagnóstico de esta enfermedad se intenta realizar en las etapas más tempranas posibles, para ello se han desarrollado nuevas técnicas de neuroimagen y parámetros metabólicos conocidos como biomarcadores de la enfermedad de Alzheimer. De éstos la imagen PET, tanto de glucosa como la específica amiloidea y las determinaciones de proteína Tau y Beta Amiloide en el líquido cefalorraquídeo se muestran como las más relevantes, hecho que las ha llevado a considerarse actualmente en los criterios diagnósticos internacionales de la EA. Paralelamente se ha intentado obtener "marcadores" cognitivos que nos ayuden al diagnóstico temprano, no sin controversias y datos contradictorios, pero conocer cómo se deteriora la función mnésica desde la normalidad hasta el síndrome amnésico completo con estudios longitudinales descriptivos ha hecho que podamos clasificar el deterioro de la memoria episódica en diferentes estadios. Este hecho permite tener una variable de estudio más precisa, concretamente estos estadios han sido propuestos por Cejudo JC, 2016 y se muestran como categorías muy descriptivas del proceso degenerativo completo, permitiendo el aumento de la precisión diagnóstica conjunto con los biomarcadores actuales y de futuro como puedan ser los sanguíneos. El estudio de relación entre los estadios propuestos por Cejudo JC y la neuroimagen mediante PET 18 FDG aporta una nueva clasificación de los estadios pre-amnésicos y amnésicos y ha llevado también al planteamiento de nuevos paradigmas en la exploración de la memoria episódica que podrían dar un mejor alcance pronóstico en el diagnóstico de la EA

The initial clinical manifestations of Alzheimer's disease (AD) have a high level of overlap with the cognitive characteristics of normal aging. Initially there are usually subjective complaints of memory not evidenced in the neuropsychological tests and then a period called mild cognitive deficit (MCI), in which changes in neuropsychological performance are detected but whose intensity does not produce a significant impact on normal activities or relationships interpersonal Currently the diagnosis of this disease is attempted in the earliest possible stages, for this new neuroimaging techniques and metabolic parameters known as biomarkers of Alzheimer's disease have been developed. Of these, the PET image, both glucose and amyloid specific and the determinations of Tau and Beta Amiloid protein in the cerebrospinal fluid are shown as the most relevant, a fact that has led them to be considered in the international diagnostic criteria of AD. At the same time we have tried to obtain cognitive "markers" that help us with early diagnosis, not without controversies and contradictory data, but knowing how the mnesic function deteriorates from normality to complete amnestic syndrome with longitudinal descriptive studies has allowed us to classify the deterioration of episodic memory in different stages. This fact allows having a more precise study variable, specifically these stages have been proposed by Cejudo JC, 2016 and they are shown as very descriptive categories of the complete degenerative process, allowing the increase of the diagnostic precision together with the current and future biomarkers such as may be the blood The study of the relationship between the stages proposed by Cejudo JC and neuroimaging using PET 18 FDG provides a new classification of pre-amnesic and amnestic stages and has also led to the proposal of new paradigms in the exploration of episodic memory that could give a better prognostic scope in the diagnosis of AD

Complejidad en la valoración del dolor en personas mayores / No disponible

La población envejecida representa uno de los segmentos poblacionales de mayor crecimiento. Con el aumento de la edad la incidencia y la prevalencia de síndromes dolorosos aumenta de forma muy importante. La fragilidad y la cronicidad de enfermedades que comportan dolor, en los pacientes mayores como segmento especial, va a seguir aumentando. El dolor es frecuentemente infravalorado por el propio paciente, entrando en la creencia de ser condición propia de la edad. La clara consecuencia de esta infravaloración es el impacto negativo sobre la salud, calidad de vida, que puede acabar en trastornos del ánimo, aislamiento social, deterioro cognitivo, inmovilidad y trastornos del sueño. Una valoración exhaustiva del dolor ha de incluir una historia clínica y examen físico completo, una valoración neuropsicológica y un examen psicopatológico, test de laboratorio adecuados y pruebas de imagen. Lo más recomendable es una aproximación multidisciplinar para poder mantener un adecuado manejo del dolor, aportando las mejores opciones, que incluyen la farmacoterapia, intervenciones, rehabilitación física y soporte psicológico

The elderly population comprises the fastest growing segment of the world’s population. As patients age, the incidence and prevalence of certain pain syndromes increase. Frailty and chronic diseases associated with pain will likely increase. Pain may be underreported as some elderly patients incorrectly believe that pain is a normal process of aging. The elderly are often either untreated or undertreated for pain. Consequences of under treatment for pain can have a negative impact on the health and quality of life of the elderly, resulting in depression, anxiety, social isolation, cognitive impairment, immobility, and sleep disturbances. A comprehensive pain assessment includes a thorough medical history and physical examination, neuropsychological and psychopathological examination, pertinent laboratory results and imaging studies. A multidisciplinary approach is recommended to investigate all possible options for optimal management, including pharmacotherapy, interventional procedures, physical rehabilitation, and psychological support

Valoración de la capacidad de conducción de vehículos en pacientes con diagnóstico de deterioro cognitivo leve y demencia / No disponible

El Deterioro Cognitivo Ligero (DCL) y la Demencia Leve pueden conllevar cambios cognitivos que afectan las capacidades instrumentales e influyen en la conducción segura. Algunas personas con alteraciones neuropsicológicas, consideradas necesarias para una correcta conducción, y habiendo superado, recientemente, las pruebas para la renovación del carné de conducir continúan utilizando su vehículo con asiduidad.Sugerimos una batería neuropsicológica, de mínimos, que permita emitir un juicio clínico acerca de la seguridad de la conducción en pacientes con DCL y/o demencia. Se estudia el nivel de concordancia entre las pruebas específicas de conducción ASDE y UFOV.Muestra de población estudiada: 184 conductores: 92 DCL (edad: X = 68,7; DS = 8,6), 55 Demencia Leve (edad: X = 72,9; DS = 6,9) y 40 controles (edad: X = 66,9; DS = 8,6), con similares características sociodemográficas.Se establecen puntos de corte para las pruebas ASDE y UFOV. Test ASEDE (control vs demencia) en subtest RD muestra una sensibilidad: 86%, especificidad: 95%; TMRA2: sensibilidad: 93%, especificidad: 95%; R2: sensibilidad: 85%, especificidad: 91%; R2: sensibilidad: 85%, especificidad: 91%. TEST UFOV sensibilidad: 88% y especificidad; 81%. Para el grupo de DCL muestra una baja sensibilidad y especificidad para ambas pruebas. Se presenta los índices de correlación entre pruebas neuropsicológicas mostrando diferencias entre sujetos de cada grupo según punto de corte de RD, TMR2, TMRA2 y RD2. Se aportan datos que sugieren la composición mínima de una batería neuropsicológica (AU)

No disponible