A Systematic Review of Neurocognitive Effects of Subanesthetic Doses of Intravenous Ketamine in Major Depressive Disorder, Post-Traumatic Stress Disorder, and Healthy Population.

BACKGROUND AND OBJECTIVE: Ketamine, a noncompetitive, high-affinity antagonist of the N-methyl-D-aspartate type glutamate receptor, has been investigated for its high efficacy and rapid antidepressant effect and, more recently, for its potential utility in post-traumatic stress disorder (PTSD). The proposal that ketamine's antidepressant and anti-suicidal mechanism may be in part due to its procognitive effect contrasts with the well-established decreased performance on spatial working memory and pattern recognition memory among long-term frequent users. We aimed to review the neurocognitive effects of subanesthetic doses of intravenous ketamine in pharmacological studies among healthy subjects and patients with PTSD or depression. METHODS: We included studies in English, among healthy adults, or with PTSD or unipolar or bipolar depression where the primary or secondary cognitive outcomes were measured by means of validated neuropsychological test. We excluded studies that reported the use of ketamine only in combination with other drugs or psychotherapy, or studies investigating emotion-laden cognitive functions. RESULTS: Ketamine administration among patients with depression and possibly with PTSD does not show significant impairment of cognitive functions in the short-term, in contrast with the immediate altered cognitive dysfunction found in healthy subjects. The potential procognitive effects of ketamine seem more pronounced in cognitive domains of executive function, which is in line with the putative molecular, cellular, and synaptic mechanisms of ketamine's therapeutic action. CONCLUSIONS: The potential procognitive effect of ketamine deserves further exploration. Whether ketamine has transient or sustained neurocognitive benefits beyond its antidepressant effects is unknown. Improved cognition by ketamine might be used to facilitate psychotherapy interventions for PTSD and depression.

Using patient aligned care team marketing to identify cognitive impairment in primary care.

INTRODUCTION: Cognitive impairment is a growing concern that is costly for individuals and health care systems and is often undiagnosed. Early recognition of cognitive impairment allows patients and families the opportunity to discuss long-term care planning and to arrange financial and legal affairs. Identification of cognitive impairment allows for better evaluation and accommodation of functional deficits. Most individuals with cognitive impairment receive care exclusively through primary care. Primary care providers are typically overburdened, and subsequently cognitive impairment may be unrecognized and untreated. Efficient methods of detecting cognitive impairment are needed in primary care. METHOD: The present investigation examined the effect of a simple marketing strategy on the frequency of referral for cognitive screening in primary care. The frequency of referral for cognitive screening was measured for the 12 months prior to and following the marketing effort. Data for the period 2 years after the marketing effort were examined to determine if increases in referral for cognitive screening were maintained. RESULTS: Results demonstrate that this modest marketing effort significantly increased the number of individuals who were referred for cognitive impairment screening, and this increase was maintained over time. Also, the majority of those who were evaluated screened positive for cognitive impairment. DISCUSSION: This brief marketing effort increased the frequency of referral for cognitive screening and identified individuals with cognitive impairment in primary care. Implications for future research and for management of cognitive impairment in primary care are detailed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).