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1.
PLoS One ; 15(3): e0226688, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32191705

RESUMEN

BACKGROUND: Schizophrenia is linked with abnormal brain neurodevelopment, on which IGF-2 (insulin-like growth factor-2) has a great impact. The purpose of this study was to assess the levels of serum IGF-2 and its binding proteins IGFBP-3 and IGFBP-7 in schizophrenia patients and the associations of these proteins with schizophrenia psychopathology and cognitive deficits. METHODS: Thirty-two schizophrenia patients and 30 healthy controls were recruited. The PANSS and a neurocognitive test battery were used to assess schizophrenic symptomatology and cognition, respectively. Serum IGF-2, IGFBP-3 and IGFBP-7 levels were determined using ELISA. RESULTS: The schizophrenia patients had a much lower content of serum IGF-2, IGFBP-3 and IGFBP-7 than controls. For the patients, IGF-2 levels were negatively correlated with the PANSS negative scores and positively associated with working memory, attention, and executive function. The correlations between IGF-2 and the PANSS negative scores, working memory or executive function were still significant after controlling for age, sex, education level, BMI, illness history and age of onset. No significant associations of IGFBP-3 or IGFBP-7 with the PANSS scores and cognitive function were observed in the patients. CONCLUSIONS: Our study demonstrates that serum IGF-2 was significantly correlated with negative and cognitive symptoms in patients with schizophrenia, suggesting that altered IGF-2 signaling may be implicated in the psychopathology and cognitive deficits in schizophrenia.


Asunto(s)
Encéfalo/fisiopatología , Disfunción Cognitiva/metabolismo , Factor II del Crecimiento Similar a la Insulina/metabolismo , Esquizofrenia/metabolismo , Adulto , Encéfalo/crecimiento & desarrollo , Estudios de Casos y Controles , Disfunción Cognitiva/sangre , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/fisiopatología , Función Ejecutiva/fisiología , Femenino , Humanos , Factor II del Crecimiento Similar a la Insulina/análisis , Masculino , Memoria a Corto Plazo/fisiología , Pruebas Neuropsicológicas , Esquizofrenia/sangre , Esquizofrenia/diagnóstico , Esquizofrenia/fisiopatología , Transducción de Señal/fisiología , Adulto Joven
2.
Medicine (Baltimore) ; 99(12): e19549, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195962

RESUMEN

BACKGROUND: Evidences suggest that cognitive training facilitates cognitive function, and most studies have targeted adults and children older than 4 years of age. This study investigated the applicability and efficacy of a tablet computer-based cognitive training program for young children with cognitive impairment of cognitive age between 18 and 36 months. METHODS: Thirty-eight children were randomly assigned to the intervention (n = 20, administered a tablet computer-based cognitive training program, for 30 minutes per session and twice a week over a period of 12 weeks) and control (n = 18, received the traditional rehabilitation program) groups. Mental scale of Bayley Scales of Infant Development II (BSID II), Pediatric Evaluation of Disability Inventory (PEDI), interest/persistence domain of the Laboratory Temperament Assessment Battery (LAP-TAB), Early Childhood Behavior Questionnaire (ECBQ), and Goal Attainment Scale (GAS) were evaluated before and after 12 weeks of therapeutic intervention. RESULTS: The tablet computer-based cognitive training program was applicable to all children in the intervention group without any problems including irritable behavior or obsession about a tablet computer. After 12 weeks, Mental scale of BSID II, PEDI (social function), LAB-TAB (observation), LAB-TAB (manipulation), and GAS showed statistically significant improvements in the intervention group, compared with the values in the control group (P < .05). After adjusting for the pre-treatment measurements and cognitive age, the tablet computer-based cognitive training program had significant effect on the post-treatment measurements of Mental scale of BSID II, PEDI (social function), LAB-TAB (observation), LAB-TAB (manipulation), and GAS (P < .05). There was no association between the change in the scores and the severity of cognitive delay in the most of the measurements, however, the self-care domain of PEDI showed a negative association with the severity of the cognitive delay (r = -0.462, P = .04). CONCLUSIONS: Application of a tablet computer-based cognitive training program was feasible and showed improvements in cognitive function in young children with cognitive impairment of cognitive age between 18 and 36 months, regardless of the severity of the cognitive delay. But severe cognitive delay can be related with less improvement in the self-care domain of PEDI. TRIAL REGISTRATION NUMBER: https://cris.nih.go.kr (KCT0002889).


Asunto(s)
Terapia Cognitivo-Conductual/instrumentación , Disfunción Cognitiva/terapia , Computadoras de Mano/estadística & datos numéricos , Intervención Educativa Precoz/métodos , Niño , Preescolar , Cognición/fisiología , Terapia Cognitivo-Conductual/métodos , Disfunción Cognitiva/diagnóstico , Evaluación de la Discapacidad , Femenino , Humanos , Lactante , Masculino , Evaluación de Resultado en la Atención de Salud , Índice de Severidad de la Enfermedad
4.
PLoS One ; 15(2): e0228679, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32017808

RESUMEN

BACKGROUND: Chronic autoimmune demyelinating polyneuropathies (CADP) result in impaired sensorimotor function. However, anecdotal clinical observations suggest the development of cognitive deficits during the course of disease. METHODS: We tested 16 patients with CADP (11 patients with chronic inflammatory demyelinating polyneuropathy, 4 patients with multifocal motor neuropathy and 1 patient with multifocal acquired demyelinating sensory and motor neuropathy) and 40 healthy controls (HC) with a neuropsychological test battery. Blood-brain-barrier dysfunction (BBBd) in patients was assessed retrospectively by analysing the cerebral spinal fluid (CSF) status at the time the diagnosis of CAPD was established. RESULTS: CADP patients failed on average in 1.7 out of 9 neuropsychological tests (SD ± 1.25, min. 0, max. 5). 50% of the CADP patients failed in at least two neuropsychological tests and 44.3% of the patients failed in at least two different cognitive domains. CADP patients exhibiting BBBd at the time of first diagnosis failed in more neuropsychological tests than patients with intact integrity of the BBB (p < 0.05). When compared directly with the HC group, CADP patients performed worse than HC in tests measuring information processing ability and speed as well as phonemic verbal fluency after adjusting for confounding covariates. CONCLUSIONS: Our results suggest that mild to moderate cognitive deficits might be present in patients with CAPD. One possible tentative explanation, albeit strong evidence is still lacking for this pathophysiological mechanism, refers to the effect of autoimmune antibodies entering the CNS via the dysfunctional blood-brain barrier typically seen in some of the CADP patients.


Asunto(s)
Disfunción Cognitiva/etiología , Polineuropatías/fisiopatología , Adulto , Anciano , Autoanticuerpos , Enfermedades Autoinmunes del Sistema Nervioso , Barrera Hematoencefálica/fisiopatología , Estudios de Casos y Controles , Disfunción Cognitiva/líquido cefalorraquídeo , Disfunción Cognitiva/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Polineuropatías/líquido cefalorraquídeo , Polineuropatías/complicaciones , Polineuropatías/patología , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/complicaciones , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/fisiopatología , Estudios Retrospectivos
5.
Health Qual Life Outcomes ; 18(1): 40, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32093697

RESUMEN

BACKGROUND: The purpose of this study was to characterize the cognitive performance of individuals with animal hoarding. METHODS: This is a cross-sectional study, in which 33 individuals between the ages of 29 to 84 (M = 61.39; SD = 12.69) with animal hoarding have been assessed. The participants completed a neurocognitive battery including measures of general cognitive functioning, visual memory and organization, verbal fluency, and verbal reasoning. RESULTS: Data suggest that individuals with animal hoarding have high rates of cognitive deficits related to visual memory and verbal reasoning. CONCLUSIONS: Based on the performance tests used, we can suggest the existence of cognitive difficulties related especially to the executive functions of individuals with animal hoarding in this sample.


Asunto(s)
Disfunción Cognitiva/diagnóstico , Trastorno de Acumulación/psicología , Adulto , Anciano , Anciano de 80 o más Años , Animales , Estudios de Casos y Controles , Gatos , Disfunción Cognitiva/complicaciones , Estudios Transversales , Perros , Función Ejecutiva/fisiología , Femenino , Trastorno de Acumulación/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Calidad de Vida
7.
JAMA ; 323(8): 764-785, 2020 02 25.
Artículo en Inglés | MEDLINE | ID: mdl-32096857

RESUMEN

Importance: Early identification of cognitive impairment may improve patient and caregiver health outcomes. Objective: To systematically review the test accuracy of cognitive screening instruments and benefits and harms of interventions to treat cognitive impairment in older adults (≥65 years) to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials through January 2019, with literature surveillance through November 22, 2019. Study Selection: Fair- to good-quality English-language studies of cognitive impairment screening instruments, and pharmacologic and nonpharmacologic treatments aimed at persons with mild cognitive impairment (MCI), mild to moderate dementia, or their caregivers. Data Extraction and Synthesis: Independent critical appraisal and data abstraction; random-effects meta-analyses and qualitative synthesis. Main Outcomes and Measures: Sensitivity, specificity; patient, caregiver, and clinician decision-making; patient function, quality of life, and neuropsychiatric symptoms; caregiver burden and well-being. Results: The review included 287 studies with more than 280 000 older adults. One randomized clinical trial (RCT) (n = 4005) examined the direct effect of screening for cognitive impairment on patient outcomes, including potential harms, finding no significant differences in health-related quality of life at 12 months (effect size, 0.009 [95% CI, -0.063 to 0.080]). Fifty-nine studies (n = 38 531) addressed the accuracy of 49 screening instruments to detect cognitive impairment. The Mini-Mental State Examination was the most-studied instrument, with a pooled sensitivity of 0.89 (95% CI, 0.85 to 0.92) and specificity of 0.89 (95% CI, 0.85 to 0.93) to detect dementia using a cutoff of 23 or less or 24 or less (15 studies, n = 12 796). Two hundred twenty-four RCTs and 3 observational studies including more than 240 000 patients or caregivers addressed the treatment of MCI or mild to moderate dementia. None of the treatment trials were linked with a screening program; in all cases, participants were persons with known cognitive impairment. Medications approved to treat Alzheimer disease (donepezil, galantamine, rivastigmine, and memantine) improved scores on the ADAS-Cog 11 by 1 to 2.5 points over 3 months to 3 years. Psychoeducation interventions for caregivers resulted in a small benefit for caregiver burden (standardized mean difference, -0.24 [95% CI, -0.36 to -0.13) over 3 to 12 months. Intervention benefits were small and of uncertain clinical importance. Conclusions and Relevance: Screening instruments can adequately detect cognitive impairment. There is no empirical evidence, however, that screening for cognitive impairment improves patient or caregiver outcomes or causes harm. It remains unclear whether interventions for patients or caregivers provide clinically important benefits for older adults with earlier detected cognitive impairment or their caregivers.


Asunto(s)
Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Tamizaje Masivo , Anciano , Cuidadores , Disfunción Cognitiva/terapia , Demencia/tratamiento farmacológico , Diagnóstico Precoz , Humanos , Vida Independiente , Tamizaje Masivo/efectos adversos , Pruebas Neuropsicológicas , Guías de Práctica Clínica como Asunto , Sensibilidad y Especificidad
8.
JAMA ; 323(8): 757-763, 2020 02 25.
Artículo en Inglés | MEDLINE | ID: mdl-32096858

RESUMEN

Importance: Dementia (also known as major neurocognitive disorder) is defined by a significant decline in 1 or more cognitive domains that interferes with a person's independence in daily activities. Dementia affects an estimated 2.4 to 5.5 million individuals in the United States, and its prevalence increases with age. Objective: To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on screening for cognitive impairment, including mild cognitive impairment and mild to moderate dementia, in community-dwelling adults, including those 65 years or older residing in independent living facilities. Population: This recommendation applies to community-dwelling older adults 65 years or older, without recognized signs or symptoms of cognitive impairment. Evidence Assessment: The USPSTF concludes that the evidence is lacking, and the balance of benefits and harms of screening for cognitive impairment cannot be determined. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in older adults. (I statement).


Asunto(s)
Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Tamizaje Masivo , Anciano , Disfunción Cognitiva/terapia , Demencia/terapia , Diagnóstico Precoz , Humanos , Vida Independiente , Tamizaje Masivo/efectos adversos , Pruebas Neuropsicológicas , Sensibilidad y Especificidad
9.
Adv Clin Exp Med ; 29(1): 115-121, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31990459

RESUMEN

BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative disorder with a characteristic clinical picture. Apart from classical movement disorders, a significant role is also played by non-motor symptoms, in particular cognitive impairments, which have a significant impact on the quality of life of the patients. Tau protein and amyloid beta are well-known non-specific biomarkers in Alzheimer's disease (AD). OBJECTIVES: The study assessed the practical value of determining tau protein and amyloid beta (Aß42) in the blood serum of patients with PD and their relationship with cognitive impairments, radiographic image and the used dose of L-DOPA. MATERIAL AND METHODS: The neuropsychological assessment was carried for 64 patients with PD. The levels of amyloid beta 1-42 (Aß42) and tau proteins in serum were also measured. RESULTS: The Aß42 level in the serum was statistically higher in patients with longer duration of the disease (p < 0.05) and those who were taking a higher dose of L-DOPA (p < 0.05). The average level of tau protein in the serum was slightly lower in the study groups than in the control group and showed no statistical significance. No correlation was found between the levels of tau protein and Aß42 and the results of neuropsychological tests. Tau protein correlated with hippocampal atrophy (p < 0.05). CONCLUSIONS: Serum levels of Aß42 and tau protein in PD may be a useful marker for the assessment of cognitive impairments. The role of L-DOPA in the process of dementia in PD remains unclear.


Asunto(s)
Enfermedad de Alzheimer , Péptidos beta-Amiloides , Disfunción Cognitiva , Enfermedad de Parkinson , Fragmentos de Péptidos , Proteínas tau , Adulto , Anciano , Péptidos beta-Amiloides/sangre , Biomarcadores/sangre , Estudios de Casos y Controles , Disfunción Cognitiva/sangre , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/complicaciones , Fragmentos de Péptidos/sangre , Calidad de Vida , Proteínas tau/sangre
10.
PLoS One ; 15(1): e0227282, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31961882

RESUMEN

BACKGROUND: We aimed to explore clinicians' communication, including the discussion of diagnosis, cause, prognosis and care planning, in routine post-diagnostic testing consultations with patients with Mild Cognitive Impairment (MCI). METHODS: Thematic content analysis was used to analyze audiotaped consultations in which 10 clinicians (eight neurologists and two geriatricians) from 7 memory clinics, disclosed diagnostic information to 13 MCI patients and their care partners. We assessed clinician-patient communication regarding diagnostic label, cause, prognosis and care planning to identify core findings. RESULTS: Core findings were: clinicians 1) differed in how they informed about the MCI label; 2) tentatively addressed cause of symptoms; 3) (implicitly) steered against further biomarker testing; 4) rarely informed about the patient's risk of developing dementia; 5) often informed about the expected course of symptoms emphasizing potential symptom stabilization and/or improvement, and; 6) did not engage in a conversation on long-term (care) planning. DISCUSSION: Clinicians' information provision about the underlying cause, prognosis and implications for long-term (care) planning in MCI could be more specific. Since most patients and care partners have a strong need to understand the patient's symptoms, and for information on the prognosis and implications for the future, clinicians' current approach may not match with those needs.


Asunto(s)
Disfunción Cognitiva/diagnóstico , Comunicación , Educación del Paciente como Asunto , Relaciones Médico-Paciente , Derivación y Consulta , Anciano , Anciano de 80 o más Años , Cuidadores/educación , Disfunción Cognitiva/etiología , Disfunción Cognitiva/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Planificación de Atención al Paciente , Pronóstico , Investigación Cualitativa , Encuestas y Cuestionarios
11.
Medicine (Baltimore) ; 99(2): e18501, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914020

RESUMEN

The frailty represents a key determinant of elderly clinical assessment, especially because it allows the identification of risk factors potentially modifiable by clinical and therapeutic interventions. The frailty assessment in elderly patients usually is made by using of Fried criteria. However, to assess the frailty in cirrhotic patients, multiple but different tools are used by researchers. Thus, we aimed to compare frailty prevalence in elderly patients with well-compensated liver cirrhosis and without cirrhosis, according to Fried criteria.Among 205 elderly patients screened, a total of 148 patients were enrolled. The patients were divided into 2 groups according to the presence/absence of well-compensated liver cirrhosis.After clinical examination with conventional scores of cirrhosis, all patients underwent anthropometric measurements, nutritional, biochemical, comorbidity, and cognitive performances. Frailty assessment was evaluated according to Fried frailty criteria.Unexpectedly, according to the Fried criteria, non-cirrhotic patients were frailer (14.2%) than well-compensated liver cirrhotic patients (7.5%). The most represented Fried criterion was the unintentional weight loss in non-cirrhotic patients (10.1%) compared to well-compensated liver cirrhotic patients (1.4%). Moreover, cumulative illness rating scale -G severity score was significantly and positively associated with frailty status (r = 0.234, P < .004). In a multivariate linear regression model, only female gender, body mass index and mini nutritional assessment resulted associated with frailty status, independently of other confounding variables.Despite the fact that elderly cirrhotic patients are considered to be frailer than the non-cirrhotic elderly patient, relying solely on "mere visual appearance," our data show that paradoxically non-cirrhotic elderly patients are frailer than elderly well-compensated liver cirrhotic patients. Thus, clinical implication of this finding is that frailty assessment performed in the well-compensated liver cirrhotic patient can identify those cirrhotic patients who may benefit from tailored interventions similarly to non-cirrhotic elderly patients.


Asunto(s)
Fragilidad/epidemiología , Hepatitis C/complicaciones , Cirrosis Hepática/complicaciones , Cirrosis Hepática/epidemiología , Anciano , Índice de Masa Corporal , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/etiología , Comorbilidad , Estudios Transversales , Femenino , Hepacivirus/aislamiento & purificación , Hepatitis C/epidemiología , Humanos , Cirrosis Hepática/diagnóstico , Masculino , Evaluación Nutricional , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad
12.
Neurology ; 94(4): e397-e406, 2020 01 28.
Artículo en Inglés | MEDLINE | ID: mdl-31888974

RESUMEN

OBJECTIVE: To determine the temporal sequence of objectively defined subtle cognitive difficulties (Obj-SCD) in relation to amyloidosis and neurodegeneration, the current study examined the trajectories of amyloid PET and medial temporal neurodegeneration in participants with Obj-SCD relative to cognitively normal (CN) and mild cognitive impairment (MCI) groups. METHOD: A total of 747 Alzheimer's Disease Neuroimaging Initiative participants (305 CN, 153 Obj-SCD, 289 MCI) underwent neuropsychological testing and serial amyloid PET and structural MRI examinations. Linear mixed effects models examined 4-year rate of change in cortical 18F-florbetapir PET, entorhinal cortex thickness, and hippocampal volume in those classified as Obj-SCD and MCI relative to CN. RESULT: Amyloid accumulation was faster in the Obj-SCD group than in the CN group; the MCI and CN groups did not significantly differ from each other. The Obj-SCD and MCI groups both demonstrated faster entorhinal cortical thinning relative to the CN group; only the MCI group exhibited faster hippocampal atrophy than CN participants. CONCLUSION: Relative to CN participants, Obj-SCD was associated with faster amyloid accumulation and selective vulnerability of entorhinal cortical thinning, whereas MCI was associated with faster entorhinal and hippocampal atrophy. Findings suggest that Obj-SCD, operationally defined using sensitive neuropsychological measures, can be identified prior to or during the preclinical stage of amyloid deposition. Further, consistent with the Braak neurofibrillary staging scheme, Obj-SCD status may track with early entorhinal pathologic changes, whereas MCI may track with more widespread medial temporal change. Thus, Obj-SCD may be a sensitive and noninvasive predictor of encroaching amyloidosis and neurodegeneration, prior to frank cognitive impairment associated with MCI.


Asunto(s)
Péptidos beta-Amiloides/análisis , Encéfalo/patología , Disfunción Cognitiva/etiología , Diagnóstico Precoz , Degeneración Nerviosa/diagnóstico , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/diagnóstico , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Degeneración Nerviosa/patología , Pruebas Neuropsicológicas , Tomografía de Emisión de Positrones
13.
Pediatrics ; 145(2)2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31924688

RESUMEN

BACKGROUND AND OBJECTIVES: Children born extremely preterm (EP) (<26 weeks' gestation) have lower cognitive scores and an increased rate of cognitive impairment compared with their term-born peers. However, the neuropsychological presentation of these EP individuals in adulthood has not been described. The aim of this study was to examine neuropsychological outcomes in early adulthood after EP birth in the 1995 EPICure cohort and to investigate if the rate of intellectual impairment changed longitudinally. METHODS: A total of 127 young adults born EP and 64 term-born controls had a neuropsychological assessment at 19 years of age examining general cognitive abilities (IQ), visuomotor abilities, prospective memory, and aspects of executive functions and language. RESULTS: Adults born EP scored significantly lower than term-born controls across all neuropsychological tests with effect sizes (Cohen's d) of 0.7 to 1.2. Sixty percent of adults born EP had impairment in at least 1 neuropsychological domain; deficits in general cognitive functioning and visuomotor abilities were most frequent. The proportion of EP participants with an intellectual impairment (IQ <70) increased by 6.7% between 11 and 19 years of age (P = .02). Visuospatial functioning in childhood predicted visuomotor functioning at 19 years. CONCLUSIONS: Adults born EP continue to perform lower than their term-born peers in general cognitive abilities as well as across a range of neuropsychological functions, indicating that these young adults do not show improvement overtime. The prevalence of intellectual impairment increased from 11 years into adulthood.


Asunto(s)
Disfunción Cognitiva/diagnóstico , Recien Nacido Extremadamente Prematuro/psicología , Trastornos de la Destreza Motora/diagnóstico , Adolescente , Estudios de Casos y Controles , Niño , Cognición , Disfunción Cognitiva/epidemiología , Estudios de Cohortes , Función Ejecutiva , Femenino , Humanos , Recién Nacido , Discapacidad Intelectual/diagnóstico , Discapacidad Intelectual/epidemiología , Lenguaje , Masculino , Memoria Episódica , Trastornos de la Destreza Motora/epidemiología , Pruebas Neuropsicológicas , Pacientes Desistentes del Tratamiento , Prevalencia , Factores Sexuales , Percepción Visual/fisiología , Escalas de Wechsler , Adulto Joven
14.
PLoS One ; 15(1): e0226494, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31978134

RESUMEN

BACKGROUND: GBA mutation carriers with PD (PD-GBA) are at higher risk of cognitive decline, but there is limited data regarding whether there are differences in gait dysfunction between GBA mutation and non-mutation carriers with PD. OBJECTIVES/METHODS: The primary aim of this study was to use quantitative inertial sensor-based gait analysis to compare gait asymmetry in 17 PD-GBA subjects, 17 non-mutation carriers with PD, and 15 healthy control subjects using parameters that had gait laterality and were markers of bradykinesia, in particular arm swing velocity and arm swing range of motion and stride length. RESULTS: Arm swing velocity was more symmetric in PD-GBA subjects vs. non-mutation carriers in the OFF state (12.5 +/- 8.3 vs. 22.9 +/- 11.8%, respectively, p = 0.018). In the ON-medication state, non-mutation carriers with PD, but not PD-GBA subjects, exhibited arm swing velocity (16.8 +/- 8.6 vs. 22.9 +/- 11.8%, p = 0.006) and arm range of motion (26.7 +/- 16.3 vs. 33.4 +/- 18.6%, p = 0.02) that was more asymmetric compared with the OFF-medication state. CONCLUSIONS: In the OFF medication state, arm swing velocity asymmetry may be a useful parameter in helping to distinguish GBA mutation carriers with PD from non-mutation carriers.


Asunto(s)
Brazo/fisiopatología , Marcha/fisiología , Glucosilceramidasa/genética , Trastornos del Movimiento/etiología , Mutación , Enfermedad de Parkinson/complicaciones , Estudios de Casos y Controles , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/etiología , Femenino , Heterocigoto , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Movimiento/diagnóstico , Enfermedad de Parkinson/genética , Rango del Movimiento Articular
15.
PLoS One ; 15(1): e0227073, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31917792

RESUMEN

OBJECTIVE: Cognitive impairment is common among hemodialysis patient, but still lack adequate screening in clinical settings. The Montreal Cognitive Assessment (MoCA) is reportedly to be a sensitive screening tool for cognitive impairment, but its clinical value in patients undergoing hemodialysis is not well established. We aimed to validate the utility of the Beijing version of the MoCA (MoCA-BJ) for detecting cognitive impairment in comparison to a detailed neuropsychological battery as the gold standard. METHODS: We assessed 613 patients undergoing hemodialysis using the MoCA-BJ, the Mini-Mental State Examination (MMSE), and a comprehensive neuropsychological battery. Cognitive dysfunction was defined by the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Spearman's correlation and linear regression were used to estimate the performance of the MoCA-BJ and MMSE in predicting cognitive impairment. A receiver operating characteristic (ROC) curve analysis was used to evaluate the utility of various cutoffs of the MoCA-BJ and MMSE for predicting cognitive impairment. RESULTS: Cognitive impairment was diagnosed in 80.91% (496/613), 75.69% (464/613), and 61.34% (376 /613) of the patients using the DSM-V, MoCA-BJ, and MMSE, respectively. Spearman's rank correlation analysis indicated that the MoCA-BJ was significantly correlated with the neuropsychological battery (rs = 0.639, p<0.001), whereas the MMSE had a weaker correlation with the battery. The area under the ROC curve for cognitive impairment diagnosis using the MoCA-BJ was 0.891 (95% confidence interval: 0.859-0.924) while using the MMSE was 0.823 (95% confidence interval: 0.786-0.860). The optimal MoCA-BJ cutoff score in discriminating patients with and without cognitive impairment was 24 points with a sensitivity of 0.877 and specificity of 0.752. CONCLUSION: The MoCA-BJ offers good sensitivity and specificity levels in detecting cognitive impairment in hemodialysis patients. These findings support the utility of the MoCA-BJ as a screening tool for cognitive impairment in Chinese patients undergoing hemodialysis.


Asunto(s)
Disfunción Cognitiva/diagnóstico , Pruebas de Estado Mental y Demencia/normas , Diálisis Renal/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , China , Disfunción Cognitiva/epidemiología , Características Culturales , Femenino , Humanos , Enfermedades Renales/epidemiología , Enfermedades Renales/terapia , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad
16.
Nervenarzt ; 91(2): 141-147, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-31712836

RESUMEN

BACKGROUND: To manage the growing numbers of people with dementia (PwD) preventive strategies are becoming more important. Therefore, the diagnostics of patients with mild cognitive impairment (PwMCI) are gaining in importance. Little is known about the current use of diagnostics tests among PwMCI in routine healthcare. The aim of the study was to examine the prevalence of diagnostic methods in newly diagnosed PwMCI over time in comparison to PwD. METHODS: The study was based on the complete nationwide patient claims data of the panel doctor services according to §295 of the German social code book V (SGB V). The incidences of PwMCI and PwD in 2011 and 2016 were identified and the use of neuropsychiatric testing, neuroimaging with computed tomography (CT) and magnetic resonance imaging (MRI), laboratory and cerebrospinal fluid (CSF) examinations was ascertained. RESULTS: In 2016 the prevalence of neuroimaging as well as of laboratory examinations was higher in PwMCI compared to PwD (29% vs. 21% and 92% vs. 88%, respectively). There were only small differences in neuropsychiatric testing (70% vs. 72%). The prevalence of CSF examinations was very low in both groups (less than 1%). Between 2011 and 2016 the prevalence of neuroimaging decreased from 36% to 29% among PwMCI, while it remained constant at around 22% for PwD. The rates of neuropsychiatric testing increased over time in both PwMCI (from 49% to 70%) and PwD (from 36% to 72%). The prevalence of laboratory examinations remained unchanged. CONCLUSION: The use of specific diagnostic methods was higher in PwMCI than in PwD. Referring to the recommendations of practice guidelines, the increase in neuropsychiatric testing is regarded as a pleasing development, whereas the decrease in neuroimaging rates and the very low prevalence of CSF examinations require improvement.


Asunto(s)
Disfunción Cognitiva , Demencia , Disfunción Cognitiva/complicaciones , Disfunción Cognitiva/diagnóstico , Demencia/complicaciones , Humanos , Prevalencia , Estudios Retrospectivos
17.
J Stroke Cerebrovasc Dis ; 29(2): 104576, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31839546

RESUMEN

BACKGROUND: Little is known on factors influencing cognitive function in rural communities. Using the Atahualpa Project cohort, we aimed to assess whether the carotid intima-media thickness (cIMT) - used as a surrogate of extracranial carotid atherosclerosis - is associated with cognitive performance and further decline in community-dwelling adults living in a rural setting. METHODS: The study included Atahualpa residents aged greater than or equal to 40 years who had ultrasound examination of the extracranial carotid arteries and a baseline Montreal Cognitive Assessment (MoCA), as well as the subset of individuals who also had a follow-up MoCA at least 1 year after baseline. Relationship between cIMT and cognitive function was assessed by means of generalized linear and longitudinal models, adjusted for relevant covariates. Mediation analysis was utilized to establish the proportion of the effect between increased cIMT and cognitive performance, which is mediated by age. RESULTS: A total of 561 individuals were included for the cross-sectional study, and 510 of them were assessed for the prospective cohort. Univariate analysis showed a significant association between increased cIMT and worse cognitive performance (P < .001), which vanishes after considering the effect of age and low scholarity. Causal mediation analysis confirms that age captures 82.6% (95% C.I.: 63.9% to 100%) of the effect of this association. There was no relationship between increased cIMT and cognitive decline in the follow-up. CONCLUSIONS: In this rural population, the association between increased cIMT and cognitive dysfunction is mostly mediated by increasing age.


Asunto(s)
Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Cognición , Envejecimiento Cognitivo/psicología , Disfunción Cognitiva/psicología , Salud Rural , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedades de las Arterias Carótidas/epidemiología , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/epidemiología , Estudios Transversales , Ecuador/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo
18.
Geriatr Gerontol Int ; 20(3): 248-255, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31851431

RESUMEN

AIM: We examined whether a newly developed computer-aided neuropsychiatric series of test, CogEvo, is necessary and sufficient for the evaluation of cognitive function in older people. METHODS: A total of 272 participants in worthwhile life activity for the prevention of decline in mobility and cognitive function were administered tests every week at 33 locations in Fukaura-machi, Japan. Basic profile information, a Mini-Mental State Examination (MMSE), a CogEvo and a clock drawing test were used in the present study. RESULTS: Our results are summarized as: (i) the total score of the CogEvo and MMSE tests decreased significantly according to age and in age group analysis; (ii) scores from the CogEvo and MMSE tests showed a significant correlation; (iii) MMSE scores showed marked ceiling effects; (iv) analysis of cognitive domains, such as orientation, attention, memory and executive function, and spatial cognition using CogEvo showed significant age-dependent impairment; (v) CogEvo discriminated three score groups of MMSE results with sensitivity and specificity of 70% and 60% in the <23 score group, 78% and 54% in the 24-26 score group, and 85% and 70% in the >27 score group, respectively; (vi) CogEvo memory tests reflected more detailed recall function than registration function; and (vii) CogEvo spatial cognition test results were correlated with test items of the MMSE and clock drawing tests. CONCLUSIONS: CogEvo is an easy and potentially useful computer-aided test battery that can be used to evaluate age-related or pathological decline in cognitive function from middle age and in preclinical stages of dementia. Geriatr Gerontol Int 2019; ••: ••-••.


Asunto(s)
Cognición , Disfunción Cognitiva/diagnóstico , Diagnóstico por Computador/normas , Adulto , Anciano , Anciano de 80 o más Años , Demencia/diagnóstico , Femenino , Evaluación Geriátrica , Humanos , Japón , Masculino , Pruebas de Estado Mental y Demencia , Persona de Mediana Edad , Sensibilidad y Especificidad
19.
Artículo en Ruso | MEDLINE | ID: mdl-31793550

RESUMEN

Article is devoted to topical issues of complex diagnosis and treatment of the consequences of traumatic brain injury (TBI) in children, adolescents and adults. Craniocerebral trauma is one of the most important problems of modern neurology, due to the high frequency and severity of disability. In recent years, there has been a steady increase in effects of TBI, a significant part of which are asthenic, autonomic, cognitive, emotional and motor disorders. Factors affecting the severity of the consequences of TBI are: the severity of the injury, the age, at which the injury occurred, the time elapsed since the injury, the localization of the lesion. After mild TBI, the structure of cognitive impairment is dominated by memory and attention disorders (75%), visual-motor coordination, as well as asthenic disorders (88%), chronic headaches (95%). After moderate and severe TBI, there are more pronounced impairment of cognitive and motor functions accompanied by pathological neurological symptoms in 94-100% of children, which leads to difficulties in learning, self-service and has a negative impact on social adaptation. The article describes in detail the modern methods of complex diagnosis, as well as pathogenetically justified methods of drug therapy of cognitive disorders in patients with the consequences of TBI. The high efficacy of the modern cytoprotective drug Cytoflavin in the treatment of the effects of TBI is shown.


Asunto(s)
Conmoción Encefálica , Lesiones Traumáticas del Encéfalo , Disfunción Cognitiva , Trastornos de la Memoria , Adolescente , Adulto , Conmoción Encefálica/complicaciones , Conmoción Encefálica/diagnóstico , Conmoción Encefálica/terapia , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/diagnóstico , Lesiones Traumáticas del Encéfalo/terapia , Niño , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/etiología , Disfunción Cognitiva/terapia , Humanos , Memoria , Trastornos de la Memoria/diagnóstico , Trastornos de la Memoria/etiología , Trastornos de la Memoria/terapia
20.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(10): 103-110, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31793551

RESUMEN

The concept of mild cognitive impairment is one of the promising directions for studying the predementia stages of different diseases. The feasibility of studying this phenomenon is due not only to a high risk of dementia, but also the potential reversibility of cognitive decline in old age. Long-term follow-up of patients shows different trajectories of cognitive decline in aging. The study of risk factors for the progression of moderate cognitive impairment provided an opportunity to highlight new horizons of prevention of dementia of various etiologies. Despite the insufficient effectiveness of drug therapy in patients with moderate cognitive impairment, exploring the opportunities for possible treatment of their subtypes seems promising from the point of view of improving clinical symptoms and a possible reduction in the rate of disease progression.


Asunto(s)
Disfunción Cognitiva , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/terapia , Progresión de la Enfermedad , Humanos , Factores de Riesgo
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