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1.
NeuroRehabilitation ; 48(2): 209-220, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33664158

RESUMEN

BACKGROUND: Acquired brain injuries often cause cognitive impairment, significantly impacting participation in rehabilitation and activities of daily living. Music can influence brain function, and thus may serve as a uniquely powerful cognitive rehabilitation intervention. OBJECTIVE: This feasibility study investigated the potential effectiveness of music-based cognitive rehabilitation for adults with chronic acquired brain injury. METHODS: The control group participated in three Attention Process Training (APT) sessions, while the experimental group participated in three Music Attention Control Training (MACT) sessions. Pre-and post- testing used the Trail Making A & B, Digit Symbol, and Brown-Peterson Task as neuropsychological tests. RESULTS: ANOVA analyses showed no significant difference between groups for Trail A Test, Digit Symbol, and Brown-Peterson Task. Trail B showed significant differences at post-test favouring MACT over APT. The mean difference time between pre-and post-tests for the Trail B Test was also significantly different between APT and MACT in favour of MACT using a two-sample t-test as well as a follow-up nonparametric Mann Whitney U-test. CONCLUSIONS: The group differences found in the Trail B tests provided preliminary evidence for the efficacy of MACT to arouse and engage attention in adults with acquired brain injury.


Asunto(s)
Lesión Encefálica Crónica/terapia , Disfunción Cognitiva/terapia , Musicoterapia/métodos , Rehabilitación Neurológica/métodos , Índice de Severidad de la Enfermedad , Actividades Cotidianas/psicología , Adulto , Anciano , Lesión Encefálica Crónica/psicología , Cognición/fisiología , Disfunción Cognitiva/psicología , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Música/psicología , Rehabilitación Neurológica/psicología , Pruebas Neuropsicológicas
2.
Nutr Metab Cardiovasc Dis ; 31(3): 950-960, 2021 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-33546942

RESUMEN

BACKGROUND & AIMS: Vascular function, blood pressure and inflammation are involved in the pathogenesis of major chronic diseases, including both cardiovascular disease (CVD) and mild cognitive impairment (MCI). This study investigated the effects of food anthocyanins on microvascular function, 24-h ambulatory blood pressure (ABP) and inflammatory biomarkers in older adults with MCI. METHODS AND RESULTS: Thirty-one participants with MCI [19 female, 12 male, mean age 75.3 (SD 6.9) years and body mass index 26.1 (SD 3.3) kg/m2], participated in a randomized, controlled, double-blind clinical trial (Australian New Zealand Clinical Trials Registry: ACTRN12618001184268). Participants consumed 250 mL fruit juice daily for 8 weeks, allocated into three groups: a) high dose anthocyanins (201 mg); b) low dose anthocyanins (47 mg); c) control. Microvascular function (Laser Speckle Contrast Imaging combined with a post-occlusive reactive hyperaemia test), 24h ABP and serum inflammatory biomarkers were assessed before and after the nutritional intervention. RESULTS: Participants in the high anthocyanins group had a reduction in serum tumor necrosis factor alpha (TNF-α) (P = 0.002) compared to controls and the low anthocyanins group (all P's > 0.05). Serum IL-6, IL-1ß, c-reactive protein, and parameters of microvascular function and 24h ABP were not altered by any treatment. CONCLUSION: A daily high dose of fruit-based anthocyanins for 8 weeks reduced concentrations of TNF-α in older adults with MCI. Anthocyanins did not alter other inflammatory biomarkers, microvascular function or blood pressure parameters. Further studies with a larger sample size and longer period of follow-up are required to elucidate whether this change in the immune response will alter CVD risk and progression of cognitive decline.


Asunto(s)
Antocianinas/administración & dosificación , Presión Sanguínea , Cognición , Disfunción Cognitiva/dietoterapia , Jugos de Frutas y Vegetales , Mediadores de Inflamación/sangre , Factor de Necrosis Tumoral alfa/sangre , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Disfunción Cognitiva/sangre , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/psicología , Método Doble Ciego , Regulación hacia Abajo , Femenino , Humanos , Masculino , Microcirculación , Nueva Gales del Sur , Factores de Tiempo , Resultado del Tratamiento
3.
Psicothema (Oviedo) ; 33(1): 70-76, feb. 2021. tab
Artículo en Inglés | IBECS | ID: ibc-199555

RESUMEN

BACKGROUND: Detecting cognitive impairment is a priority for health systems. The aim of this study is to create normative data on screening tests (MMSE, GDS and MFE) for middle-aged and older Spanish adults, considering the effects of sociodemographic factors. METHOD: A total of 2,030 cognitively intact subjects who lived in the community, aged from 50 to 88 years old, participated voluntarily in SCAND consortium studies. The statistical procedure included the conversion of percentile ranges into scalar scores. Secondly, the effects of age, educational level and gender were verified. Linear regressions were used to calculate the scalar adjusted scores. Cut-off values for each test were also calculated. RESULTS: Scalar scores and percentiles corresponding to MMSE, GDS-15 and MFE are shown. An additional table is provided which shows the points that must be added or subtracted from MMSE score depending on the subject's educational level. CONCLUSIONS: The current norms should provide clinically useful data for evaluating Spanish people aged 50 to 88 years old and should contribute to improving the detection of initial symptoms of cognitive impairment in people living in the community, taking into account the influence of gender, age and educational level


ANTECEDENTES: detectar el deterioro cognitivo es una prioridad del sistema sanitario. El objetivo de este estudio es la presentación de datos normativos de pruebas de cribado (MMSE, GDS y MFE) para adultos españoles de mediana edad y adultos mayores, considerando los efectos de factores sociodemográficos. MÉTODO: en los estudios realizados por el consorcio SCAND participaron voluntariamente 2.030 personas cognitivamente sanas, de 50 a 88 años, residentes en su comunidad. El procedimiento estadístico supuso la conversión de rangos percentiles en puntuaciones escalares. Posteriormente, se comprobaron los efectos de la edad, el nivel educativo y el género. Se utilizaron regresiones lineales para calcular las puntuaciones escalares ajustadas. También se calcularon los puntos de corte para cada prueba. RESULTADOS: se muestran las puntuaciones escalares y los percentiles correspondientes a MMSE, GDS-15 y MFE. Además, se presenta una tabla que muestra los puntos que deben sumarse o restarse a la puntuación del MMSE dependiendo del nivel educativo del individuo. CONCLUSIONES: los datos normativos presentados tienen una utilidad clínica para evaluar a población española de 50 a 88 años, y contribuyen a mejorar la detección de los síntomas iniciales del deterioro cognitivo teniendo en cuenta la influencia del género, la edad y el nivel educativo


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/diagnóstico , Pruebas de Estado Mental y Demencia/normas , Envejecimiento Cognitivo/psicología , Escala del Estado Mental/normas , Pruebas Neuropsicológicas/normas , Disfunción Cognitiva/psicología , Evaluación Geriátrica/estadística & datos numéricos , Modelos Lineales , Escolaridad
4.
J Stroke Cerebrovasc Dis ; 30(4): 105608, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33461024

RESUMEN

OBJECTIVES: There has been a growing interest in whether carotid revascularization may reverse cognitive decline. In this study the aim was to assess cognitive changes after carotid artery endarterectomy and stenting, using neuropsychological assessment with MoCA and CANTAB test. MATERIALS AND METHODS: Seventy patients with asymptomatic carotid artery stenosis, qualified for CEA (study group A) and CAS (study group B) have been prospectively assessed. 20 patients with lower extremity artery disease (control group C) and 15 patients qualified for inguinal hernia surgery (control group D) have served as a control group. Patients have been evaluated 1 day before surgery and 6 months after, using MoCA and CANTAB test. Logistic regression models were built to determine variables affecting cognitive performance. RESULTS: After the procedure in the study group A the cognitive evaluation showed improvement in 5 cognitive domains tested in MoCA: visuospatial/executive (p=.0496), naming (p=.0831), language (p=.0009), abstraction (p=.0126) and delayed recall (p=.0016). In CANTAB there were improvement in PAL (p=.0290) and SWM (p=.0105). In study group B positive cognitive changes were seen in visuospatial/executive (p=.0827) and delayed recall (p=.0041) tested with MoCA and in PAL (PALFAMS28 p=.0315, PALNPR28 p=.0090, PALTEA28 p=.0058) and SWM (p=.0882) tested with CANTAB. Using a regression model, the only strong predictors of cognitive improvement on the follow-up visit were younger age and lower MoCA score on the first visit. CONCLUSIONS: Carotid revascularization, both open and endovascular, lead to cognitive improvement in patients with severe carotid stenosis and cognitive decline. This effect seems to be stronger in younger patients with worst cognitive performance before surgery.


Asunto(s)
Estenosis Carotídea/cirugía , Cognición , Disfunción Cognitiva/psicología , Endarterectomía Carotidea , Procedimientos Endovasculares , Factores de Edad , Anciano , Enfermedades Asintomáticas , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Estudios de Casos y Controles , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/etiología , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Estudios Prospectivos , Recuperación de la Función , Índice de Severidad de la Enfermedad , Stents , Factores de Tiempo , Resultado del Tratamiento
5.
NeuroRehabilitation ; 48(1): 97-108, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33386825

RESUMEN

BACKGROUND: The negative impact of cognitive dysfunction on motor rehabilitation as a relearning-process is well known in stroke patients. However, evidence for combined cognitive and motor training (CMT) is lacking. OBJECTIVE: To evaluate the effects of combined CMT in early stroke rehabilitation. METHODS: In a controlled pilot study, 29 moderately affected stroke patients with low-level motor performance and cognitive impairment received motor therapy plus either cognitive (experimental group, EG) or low-frequency ergometer training (control group, CG) for eight days. RESULTS: Both groups improved their motor functioning significantly. After training, between-group comparison revealed significant differences for cognitive flexibility and trends for set-shifting, working memory, and reaction control in favor of the EG. Within-group effects showed improvement across all cognitive domains in the EG, which correlated with gains in bed-mobility, while the CG showed no significant improvement in cognition. Rather, a trend towards reaction control decline was observed, which correlated with less functional progression and recovery. Furthermore, a decline in cognitive flexibility, set-shifting, and working memory was descriptively observed. CONCLUSIONS: Combined CMT may enhance cognition and motor relearning early after stroke and is superior to single motor training. Further studies are needed to replicate these results and investigate long-term benefits.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Disfunción Cognitiva/terapia , Función Ejecutiva/fisiología , Modalidades de Fisioterapia , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/terapia , Anciano , Anciano de 80 o más Años , Cognición/fisiología , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/psicología , Terapia Combinada/métodos , Terapia Combinada/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Destreza Motora/fisiología , Modalidades de Fisioterapia/psicología , Proyectos Piloto , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología , Rehabilitación de Accidente Cerebrovascular/psicología , Resultado del Tratamiento
6.
Neurology ; 96(9): e1347-e1357, 2021 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-33408147

RESUMEN

OBJECTIVE: To understand the time course of ß-amyloid (Aß) deposition in the brain, which is crucial for planning therapeutic trials of Aß-lowering therapies in Alzheimer disease (AD). METHODS: Two samples of participants from the Alzheimer's Disease Neuroimaging Initiative were studied with [18F]Florbetapir (FBP) Aß PET and followed for up to 9 years. Sample A included 475 cognitively normal (CN) older people and those with mild cognitive impairment (MCI) and AD and sample B included 220 CN Aß- individuals. We examined the trajectory of FBP over time in sample A and the incidence rate of conversion from negative to positive Aß PET scans in sample B. RESULTS: The relationship between time and brain Aß was sigmoidal, taking 6.4 years to transition from amyloid negative to positive and another 13.9 years to the onset of MCI. Aß deposition rates began to slow only 3.8 years after reaching the positivity threshold. The incidence rate for scan positivity was 38/1,000 person-years, and factors associated with conversion were age, baseline FBP, and being a female APOE ε4 carrier. Among CN Aß- individuals, FBP slopes were associated with rates of memory decline and brain tau measured with [18F]Flortaucipir PET 5 years after baseline. CONCLUSIONS: Lowering brain Aß must be accomplished early in the evolution of AD. Transitions of PET scans from Aß- to Aß+ should be predictable, and it is reasonable to expect that lowering rates of Aß even in early stages could produce clinically significant benefits.


Asunto(s)
Envejecimiento/metabolismo , Enfermedad de Alzheimer/metabolismo , Péptidos beta-Amiloides/metabolismo , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/psicología , Compuestos de Anilina , Apolipoproteína E4/genética , Carbolinas , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/metabolismo , Disfunción Cognitiva/psicología , Glicoles de Etileno , Femenino , Estudios de Seguimiento , Heterocigoto , Humanos , Estudios Longitudinales , Masculino , Pruebas Neuropsicológicas , Tomografía de Emisión de Positrones , Caracteres Sexuales , Proteínas tau/genética
7.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-33509854

RESUMEN

Early theories of schizophrenia considered the illness as a fragmentation of mental content in response to psychological trauma. Here we present a case of very late onset schizophrenia in a previously high-functioning man in his mid-60s, precipitated by having lost his family in a terrorist attack, while he was living in Africa. He presented with symptoms consistent with post-traumatic stress disorder, however also exhibited visual and auditory hallucinations and marked deterioration in daily functioning. He showed mild impairment on cognitive testing, however brain imaging and screening for reversible causes of cognitive impairment were normal. The case highlights the need for a formulation-based approach to understanding and managing responses to severe trauma, from resolution through to psychotic disintegration.


Asunto(s)
Disfunción Cognitiva/psicología , Alucinaciones/psicología , Trastornos Psicóticos/psicología , Esquizofrenia , Autoabandono/psicología , Trastornos por Estrés Postraumático/psicología , Anciano , Aflicción , Humanos , Enfermedades de Inicio Tardío , Masculino , Psicología del Esquizofrénico , Terrorismo
8.
J Alzheimers Dis ; 79(3): 1015-1021, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33386809

RESUMEN

We explored the impact of the Spanish COVID-19 strict home confinement on mental health and cognition in non-infected subjects (N = 16, 60-80 years) diagnosed with subjective cognitive decline and APOEɛ3/ɛ4 carriers. Mental health was monitored for 2 months on a daily, weekly, or monthly basis, and compared to pre-confinement values. Emotional distress, anxiety, and depression scores increased to pathological threshold values during and after confinement. Those with lower mood during confinement experienced a decline in their mood after confinement. Cognition did not change. These preliminary results suggest that mental health consequences of corona measures in preclinical stages of Alzheimer's disease should be further evaluated.


Asunto(s)
Enfermedad de Alzheimer/psicología , Trastornos del Conocimiento/psicología , Salud Mental , Cuarentena/psicología , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/genética , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/genética , Trastornos de Ansiedad/psicología , Apolipoproteína E3/genética , Apolipoproteína E4/genética , /terapia , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/genética , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/genética , Disfunción Cognitiva/psicología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/genética , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Distrés Psicológico , Riesgo , España
9.
J Nutr Health Aging ; 25(2): 165-171, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33491030

RESUMEN

OBJECTIVES: Previous studies have reported a relationship between low protein intake and cognitive decline and have suggested that this association may be related to specific amino acid intake. However, the effects of amino acid intake on the maintenance of cognitive function have yet to be clarified. We examined the longitudinal association between dietary amino acid intake and cognitive function in community-dwelling older adults. DESIGN: Longitudinal epidemiological study. SETTING: Community-based setting. PARTICIPANTS: This study comprised 427 study participants aged 60-82 years with no cognitive decline, defined as a Mini-Mental State Examination (MMSE) score of >27 at baseline, who also participated in a follow-up. The average and standard deviation of the follow-up period was 8.2 ± 0.3 years. MEASUREMENTS: Dietary intake was assessed using three-day dietary records at baseline. Participants were classified into quartiles (Q1-Q4) based on the intake of 19 amino acids for males and females. Next, we classified participants into Q1 and Q2-Q4 groups. Cognitive function was assessed using the MMSE both at baseline and at follow-up. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between the Q1 group and cognitive decline (MMSE ≤27), using the Q2-Q4 group as a reference group. Covariates were age, sex, body mass index, years of education, severity of depressive symptoms, history of lifestyle diseases (hypertension, dyslipidemia, diabetes mellitus, stroke, and ischemic heart disease), energy intake (kcal/d), protein intake (g/d), and MMSE score at baseline. RESULTS: Cognitive decline was present in 133 (31.1%) participants. After adjustment for covariates, including total protein intake, the ORs (95% CIs) for cognitive decline were 2.40 (1.21-4.75) for lysine, 2.05 (1.02-4.09) for phenylalanine, 2.18 (1.09-4.34) for threonine, and 2.10 (1.06-4.15) for alanine. CONCLUSION: The results suggest that lysine, phenylalanine, threonine, and alanine intake is important for the maintenance of cognitive function in older people, independent of total protein intake.


Asunto(s)
Aminoácidos/metabolismo , Cognición/fisiología , Dieta/métodos , Anciano , Anciano de 80 o más Años , Aminoácidos/administración & dosificación , Disfunción Cognitiva/psicología , Estudios Epidemiológicos , Femenino , Humanos , Vida Independiente , Japón , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores de Tiempo
10.
Neurology ; 96(7): e975-e985, 2021 02 16.
Artículo en Inglés | MEDLINE | ID: mdl-33443136

RESUMEN

OBJECTIVE: To assess the frequency of biologically defined Alzheimer disease (AD) in relation to age, sex, APOE ε4, and clinical diagnosis in a prospective cohort study evaluated with amyloid-PET and tau-PET. METHODS: We assessed cognitively unimpaired (CU) elderly (n = 166), patients with amnestic mild cognitive impairment (n = 77), and patients with probable AD dementia (n = 62) who underwent evaluation by dementia specialists and neuropsychologists in addition to amyloid-PET with [18F]AZD4694 and tau-PET with [18F]MK6240. Individuals were grouped according to their AD biomarker profile. Positive predictive value for biologically defined AD was assessed in relation to clinical diagnosis. Frequency of AD biomarker profiles was assessed using logistic regressions with odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The clinical diagnosis of probable AD dementia demonstrated good agreement with biologically defined AD (positive predictive value 85.2%). A total of 7.88% of CU were positive for both amyloid-PET and tau-PET. Frequency of biologically defined AD increased with age (OR 1.14; p < 0.0001) and frequency of APOE ε4 allele carriers (single ε4: OR 3.82; p < 0.0001; double ε4: OR 17.55, p < 0.0001). CONCLUSION: Whereas we observed strong, but not complete, agreement between clinically defined probable AD dementia and biomarker positivity for both ß-amyloid and tau, we also observed that biologically defined AD was not rare in CU elderly. Abnormal tau-PET was almost exclusively observed in individuals with abnormal amyloid-PET. Our results highlight that even in tertiary care memory clinics, detailed evaluation by dementia specialists systematically underestimates the frequency of biologically defined AD and related entities. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that biologically defined AD (abnormal amyloid PET and tau PET) was observed in 85.2% of people with clinically defined AD and 7.88% of CU elderly.


Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Apolipoproteína E4/genética , Encéfalo/diagnóstico por imagen , Cognición/fisiología , Disfunción Cognitiva/diagnóstico , Factores de Edad , Anciano , Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/genética , Enfermedad de Alzheimer/psicología , Péptidos beta-Amiloides/metabolismo , Encéfalo/metabolismo , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/genética , Disfunción Cognitiva/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Tomografía de Emisión de Positrones , Factores Sexuales , Proteínas tau/metabolismo
11.
Neurology ; 96(9): e1358-e1368, 2021 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-33408150

RESUMEN

OBJECTIVE: To determine whether the Alzheimer disease (AD) dementia conversion-related pattern (ADCRP) on [18F]FDG PET can serve as a valid predictor for the development of AD dementia, the individual expression of the ADCRP (subject score) and its prognostic value were examined in patients with mild cognitive impairment (MCI) and biologically defined AD. METHODS: A total of 269 patients with available [18F]FDG PET, [18F]AV-45 PET, phosphorylated and total tau in CSF, and neurofilament light chain in plasma were included. Following the AT(N) classification scheme, where AD is defined biologically by in vivo biomarkers of ß-amyloid (Aß) deposition ("A") and pathologic tau ("T"), patients were categorized to the A-T-, A+T-, A+T+ (AD), and A-T+ groups. RESULTS: The mean subject score of the ADCRP was significantly higher in the A+T+ group compared to each of the other group (all p < 0.05) but was similar among the latter (all p > 0.1). Within the A+T+ group, the subject score of ADCRP was a significant predictor of conversion to dementia (hazard ratio, 2.02 per z score increase; p < 0.001), with higher predictive value than of alternative biomarkers of neurodegeneration (total tau and neurofilament light chain). Stratification of A+T+ patients by the subject score of ADCRP yielded well-separated groups of high, medium, and low conversion risks. CONCLUSIONS: The ADCRP is a valuable biomarker of neurodegeneration in patients with MCI and biologically defined AD. It shows great potential for stratifying the risk and estimating the time to conversion to dementia in patients with MCI and underlying AD (A+T+). CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that [18F]FDG PET predicts the development of AD dementia in individuals with MCI and underlying AD as defined by the AT(N) framework.


Asunto(s)
Enfermedad de Alzheimer/diagnóstico por imagen , Disfunción Cognitiva/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/psicología , Péptidos beta-Amiloides/líquido cefalorraquídeo , Biomarcadores , Disfunción Cognitiva/psicología , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Fluorodesoxiglucosa F18 , Humanos , Masculino , Persona de Mediana Edad , Proteínas de Neurofilamentos/líquido cefalorraquídeo , Pruebas Neuropsicológicas , Tomografía de Emisión de Positrones , Valor Predictivo de las Pruebas , Pronóstico , Radiofármacos , Medición de Riesgo , Proteínas tau/líquido cefalorraquídeo
12.
J Stroke Cerebrovasc Dis ; 30(3): 105568, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33423868

RESUMEN

BACKGROUND: Recent studies have demonstrated an association between the gut microbiome and cognitive function. However, the associations between the gut microbiome and brain parenchyma damage, and their underlying mechanisms, remain unclear. MATERIALS AND METHODS: We performed a cross-sectional sub-analysis using data from our prospective cohort study to determine the association between the gut microbiome and cerebral small vessel disease (SVD). We assessed patient demographics, risk factors, cognitive function, brain imaging, voxel-based specific regional analysis system for Alzheimer's Disease (VSRAD, indicating brain atrophy), and the gut microbiome as indicated by enterotypes and faecal microbiome metabolites. We then analysed the associations between total SVD scores, cognitive function, and the gut microbiome. RESULTS: We analysed data from 87 patients without dementia or a history of stroke, 64 of whom exhibited mild cognitive impairment. Higher total SVD scores were associated with cognitive decline and behavioural and psychological symptoms. Compared with all other patients, patients with enterotype I (Bacteroides >30%) were more likely to have cognitive decline (median scores: Mini-Mental State Examination, 25 vs. 27, P = 0.047; Clinical Dementia Rating-Sum of Boxes, 1.5 vs. 0.5, P = 0.002) and present with cerebral SVD and high VSRAD scores (1.01 vs. 0.57, P = 0.012). Furthermore, faecal metabolites were significantly higher in patients with higher total SVD scores compared with those with lower scores. Multivariable logistic regression analyses indicated that certain gut microbiomes may double the risk of white matter hyperintensity. CONCLUSIONS: The gut microbiome is associated with cerebral SVD.


Asunto(s)
Bacterias/clasificación , Enfermedades de los Pequeños Vasos Cerebrales/microbiología , Cognición , Disfunción Cognitiva/microbiología , Microbioma Gastrointestinal , Intestinos/microbiología , Leucoencefalopatías/microbiología , Anciano , Anciano de 80 o más Años , Bacterias/aislamiento & purificación , Enfermedades de los Pequeños Vasos Cerebrales/diagnóstico por imagen , Enfermedades de los Pequeños Vasos Cerebrales/psicología , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/psicología , Estudios Transversales , Imagen de Difusión por Resonancia Magnética , Heces/microbiología , Femenino , Humanos , Leucoencefalopatías/diagnóstico por imagen , Leucoencefalopatías/psicología , Masculino , Pruebas de Estado Mental y Demencia , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo
13.
Med Sci Monit ; 27: e930886, 2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33487628

RESUMEN

Alterations in brain functioning, especially in regions associated with cognition, can result from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and are predicted to result in various psychiatric diseases. Recent studies have shown that SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) can directly or indirectly affect the central nervous system (CNS). Therefore, diseases associated with sequelae of COVID-19, or 'long COVID', also include serious long-term mental and cognitive changes, including the condition recently termed 'brain fog'. Hypoxia in the microenvironment of select brain areas may benefit the reproductive capacity of the virus. It is possible that in areas of cerebral hypoxia, neuronal cell energy metabolism may become compromised after integration of the viral genome, resulting in mitochondrial dysfunction. Because of their need for constant high metabolism, cerebral tissues require an immediate and constant supply of oxygen. In hypoxic conditions, neurons with the highest oxygen demand become dysfunctional. The resulting cognitive impairment benefits viral spread, as infected individuals exhibit behaviors that reduce protection against infection. The effects of compromised mitochondrial function may also be an evolutionary advantage for SARS-CoV-2 in terms of host interaction. A high viral load in patients with COVID-19 that involves the CNS results in the compromise of neurons with high-level energy metabolism. Therefore, we propose that selective neuronal mitochondrial targeting in SARS-CoV-2 infection affects cognitive processes to induce 'brain fog' and results in behavioral changes that favor viral propagation. Cognitive changes associated with COVID-19 will have increasing significance for patient diagnosis, prognosis, and long-term care.


Asunto(s)
/metabolismo , Disfunción Cognitiva/metabolismo , Conductas Relacionadas con la Salud , Hipoxia Encefálica/metabolismo , Mitocondrias/metabolismo , Neuronas/metabolismo , /fisiología , /complicaciones , /psicología , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/psicología , Metabolismo Energético , Humanos , Hipoxia Encefálica/fisiopatología , Hipoxia Encefálica/psicología , Viabilidad Microbiana , Carga Viral , Replicación Viral
14.
Ann Neurol ; 89(3): 587-597, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33349939

RESUMEN

OBJECTIVE: This study was undertaken to identify preoperative predictive factors of long-term motor outcome in a large cohort of consecutive Parkinson disease (PD) patients with bilateral subthalamic nucleus deep brain stimulation (STN-DBS). METHODS: All consecutive PD patients who underwent bilateral STN-DBS at the Grenoble University Hospital (France) from 1993 to 2015 were evaluated before surgery, at 1 year (short-term), and in the long term after surgery. All available demographic variables, neuroimaging data, and clinical characteristics were collected. Preoperative predictors of long-term motor outcome were investigated by performing survival and univariate/multivariate Cox regression analyses. Loss of motor benefit from stimulation in the long term was defined as a reduction of less than 25% in the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III scores compared to the baseline off-medication scores. As a secondary objective, potential predictors of short-term motor outcome after STN-DBS were assessed by performing univariate and multivariate linear regression analyses. RESULTS: In the long-term analyses (mean follow-up = 8.4 ± 6.26 years, median = 10 years, range = 1-17 years), 138 patients were included. Preoperative higher frontal score and off-medication MDS-UPDRS part III scores predicted a better long-term motor response to stimulation, whereas the presence of vascular changes on neuroimaging predicted a worse motor outcome. In 357 patients with available 1-year follow-up, preoperative levodopa response, tremor dominant phenotype, baseline frontal score, and off-medication MDS-UPDRS part III scores predicted the short-term motor outcome. INTERPRETATION: Frontal lobe dysfunction, disease severity in the off-medication condition, and the presence of vascular changes on neuroimaging represent the main preoperative clinical predictors of long-term motor STN-DBS effects. ANN NEUROL 2021;89:587-597.


Asunto(s)
Estimulación Encefálica Profunda , Enfermedad de Parkinson/terapia , Núcleo Subtalámico , Adulto , Anciano , Trastornos Cerebrovasculares/diagnóstico por imagen , Trastornos Cerebrovasculares/epidemiología , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/psicología , Función Ejecutiva , Femenino , Estudios de Seguimiento , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pruebas Neuropsicológicas , Enfermedad de Parkinson/epidemiología , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/psicología , Pronóstico , Modelos de Riesgos Proporcionales , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
15.
Am J Physiol Heart Circ Physiol ; 320(2): H740-H761, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33337961

RESUMEN

Over two-thirds of individuals aged 65 and older are obese or overweight in the United States. Epidemiological data show an association between the degree of adiposity and cognitive dysfunction in the elderly. In this review, the pathophysiological roles of microvascular mechanisms, including impaired endothelial function and neurovascular coupling responses, microvascular rarefaction, and blood-brain barrier disruption in the genesis of cognitive impairment in geriatric obesity are considered. The potential contribution of adipose-derived factors and fundamental cellular and molecular mechanisms of senescence to exacerbated obesity-induced cerebromicrovascular impairment and cognitive decline in aging are discussed.


Asunto(s)
Barrera Hematoencefálica/fisiopatología , Cognición , Disfunción Cognitiva/fisiopatología , Endotelio Vascular/fisiopatología , Microvasos/fisiopatología , Acoplamiento Neurovascular , Obesidad/fisiopatología , Factores de Edad , Anciano , Animales , Barrera Hematoencefálica/metabolismo , Envejecimiento Cognitivo , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/prevención & control , Disfunción Cognitiva/psicología , Endotelio Vascular/metabolismo , Femenino , Humanos , Masculino , Microcirculación , Microvasos/metabolismo , Obesidad/epidemiología , Obesidad/psicología , Obesidad/terapia , Medición de Riesgo , Factores de Riesgo
16.
Neurosci Lett ; 743: 135588, 2021 01 19.
Artículo en Inglés | MEDLINE | ID: mdl-33359543

RESUMEN

INTRODUCTION: Mild cognitive dysfunction has been implicated in a number of psychiatric diseases and affects social functioning. Although clinical criteria were recently proposed for autoimmune psychosis (AP), biomarkers have not yet been established for the severity and prognosis of cognitive dysfunction. We herein investigated the relationships between 3 types of serum antibodies and cognitive dysfunction in chronic psychiatric patients suspected of AP. METHODS: We included 31 patients suspected of AP and obtained information on their clinical characteristics. Three types of autoantibodies (the anti-N-methyl-D-aspartate receptor (anti-NMDAR Ab), anti-N-terminal of GluN1 (anti-GluN1-NT Ab), and anti-thyroid antibodies) were evaluated in serum. Cognitive function was assessed using Wechsler Adult Intelligence Scale-III. We examined the relationships between serum autoantibodies and cognitive dysfunction in patients using multiple regression models. RESULTS: Serum titers of anti-GluN1-NT Ab significantly contributed to the estimated score of working memory (B= -55.85, ß= -0.46, p= 0.01), while no correlation was observed between the other 2 types of antibodies and cognitive function. CONCLUSIONS: The present results indicate the potential of serum anti-GluN1-NT Ab as a biomarker for the severity and prognosis of cognitive dysfunction underlying various psychiatric symptoms in patients with AP. The pathological significance of anti-GluN1-NT Ab needs to be verified in future studies.


Asunto(s)
Autoanticuerpos/sangre , Enfermedades Autoinmunes del Sistema Nervioso/sangre , Disfunción Cognitiva/sangre , Proteínas del Tejido Nervioso/sangre , Trastornos Psicóticos/sangre , Receptores de N-Metil-D-Aspartato/sangre , Adulto , Enfermedades Autoinmunes del Sistema Nervioso/epidemiología , Enfermedades Autoinmunes del Sistema Nervioso/psicología , Biomarcadores/sangre , Enfermedad Crónica , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/psicología , Femenino , Células HEK293 , Humanos , Masculino , Persona de Mediana Edad , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/psicología
17.
Neurology ; 96(5): e709-e718, 2021 02 02.
Artículo en Inglés | MEDLINE | ID: mdl-33380500

RESUMEN

OBJECTIVE: To determine the association between hypertensive disorders of pregnancy (HDP) and cognitive impairment 15 years after pregnancy, we measured cognitive performance in 115 women with a history of HDP and in 481 women with a previous normotensive pregnancy. METHODS: This was a nested cohort study embedded in a population-based prospective cohort from early pregnancy onwards. Cognitive function was assessed with cognitive tests 15 years after the index pregnancy (median 14.7 years, 90% range [13.9-16.1]). Cognitive performance was measured in different cognitive domains: executive function, processing speed, verbal memory, motor function, and visuospatial ability. A global cognition factor (g-factor) was derived from principal component analysis. RESULTS: Of the women with HDP, 80 (69.6%) had gestational hypertension (GH) and 35 (30.4%) had preeclampsia. Women with HDP had a lower g-factor than women with a previous normotensive pregnancy (mean -0.22, 90% range [-2.06-1.29]). HDP was negatively associated with the 15-word learning test: immediate recall (-0.25, 95% CI [-0.44 to -0.06]) and delayed recall (-0.30, 95% CI [-0.50 to -0.10]). Women with GH perform significantly worse on their 15-word learning test than women with a previous normotensive pregnancy. CONCLUSION: A history of HDP is independently associated with poorer working memory and verbal learning 15 years after pregnancy. This association is mainly driven by women with GH. Clinicians and women who experienced HDP should be aware of this risk.


Asunto(s)
Cognición , Disfunción Cognitiva/epidemiología , Función Ejecutiva , Hipertensión Inducida en el Embarazo/epidemiología , Memoria , Preeclampsia/epidemiología , Adulto , Antihipertensivos/uso terapéutico , Estudios de Casos y Controles , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/psicología , Estudios de Cohortes , Depresión/epidemiología , Depresión/psicología , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Recuerdo Mental , Persona de Mediana Edad , Pruebas Neuropsicológicas , Embarazo , Análisis de Componente Principal , Estudios Prospectivos , Desempeño Psicomotor , Reconocimiento en Psicología , Procesamiento Espacial , Test de Stroop
18.
Neurosci Lett ; 740: 135430, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33075423

RESUMEN

Cognitive decline is evident in the elderly and it affects speech perception and foreign language learning. A listen-and-repeat training with a challenging speech sound contrast was earlier found to be effective in young monolingual adults and even in advanced L2 university students at the attentive and pre-attentive levels. This study investigates foreign language speech perception in the elderly with the same protocol used with the young adults. Training effects were measured with attentive behavioural measures (N = 9) and with electroencephalography measuring the pre-attentive mismatch negativity (MMN) response (N = 10). Training was effective in identification, but not in discrimination and there were no changes in the MMN. The most attention demanding perceptual functions which benefit from experience-based linguistic knowledge were facilitated through training, whereas pre-attentive processing was unaffected. The elderly would probably benefit from different training types compared to younger adults.


Asunto(s)
Envejecimiento/psicología , Fonética , Percepción del Habla/fisiología , Anciano , Atención , Disfunción Cognitiva/psicología , Discriminación en Psicología , Electroencefalografía , Femenino , Humanos , Lenguaje , Aprendizaje , Masculino , Persona de Mediana Edad , Multilingüismo , Desempeño Psicomotor/fisiología , Tiempo de Reacción , Adulto Joven
19.
Biomed Pharmacother ; 133: 111088, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33378982

RESUMEN

Alzheimer's disease (AD) is a neurodegenerative condition mostly communal in people of advanced years accompanying various dysfunctionalities especially cognitive impairments. A number of cellular damages, such as amyloid-beta aggregation, tau protein hyperphosphorylation, some neurotransmitter imbalances, apoptosis, oxidative stress, and inflammatory responses are responsible for AD incidence. As a reason for inadequate efficacy, side effects, and pharmacokinetic problems of conventional drugs used for AD, the discovery of novel therapeutic agents with multi-targeted potential is desirable. Protective properties of phytochemicals combat numerous diseases and their vast acceptance and demand in human beings encouraged scientists to assess their effective activities. Zingiber officinale, gingerol, shogaol, and borneol were evaluated against memory impairments. Online databases including; Web of Science, Scopus, Embase, Pubmed, ProQuest, ScienceDirect, and Cochrane Library were searched until 3th February 2020. In vitro, in vivo, and clinical studies are included after screening their eligibility. Mostly interventive mechanisms such as; oxidative stress, neuroinflammation, and apoptosis are described. Correlation between the pathogenesis of AD and signaling pathways is explicated. Results and scores of cognition measurements are clarified due to in vivo studies and clinical trials. Some traditional aspects of consuming ginger in AD are also mentioned in the present review. In accumulation ginger and its components possess great potency for improving and abrogating memory dysfunctions but conducting further studies to evaluate their pharmacological and pharmaceutical aspects is required.


Asunto(s)
Enfermedad de Alzheimer/tratamiento farmacológico , Encéfalo/efectos de los fármacos , Cognición/efectos de los fármacos , Disfunción Cognitiva/tratamiento farmacológico , Jengibre , Memoria/efectos de los fármacos , Nootrópicos/uso terapéutico , Extractos Vegetales/uso terapéutico , Enfermedad de Alzheimer/metabolismo , Enfermedad de Alzheimer/fisiopatología , Enfermedad de Alzheimer/psicología , Animales , Apoptosis/efectos de los fármacos , Encéfalo/metabolismo , Encéfalo/patología , Encéfalo/fisiopatología , Disfunción Cognitiva/patología , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/psicología , Modelos Animales de Enfermedad , Jengibre/química , Humanos , Mediadores de Inflamación/metabolismo , Nootrópicos/aislamiento & purificación , Estrés Oxidativo/efectos de los fármacos , Extractos Vegetales/aislamiento & purificación
20.
Support Care Cancer ; 29(1): 247-254, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32346799

RESUMEN

PURPOSE: Hematopoietic stem cell transplant (HSCT) recipients are at risk for cognitive decline. Cross-sectional studies show patients' complaints of cognitive decline do not correlate well with concurrently measured objective neuropsychological performance, but rather with emotional variables and health-related quality of life. This longitudinal study investigated whether patient self-report of cognitive status would be concordant with objectively measured neuropsychological performance after accounting for change from their own pre-transplant objective baseline. METHODS: Pre-HSCT and at 30 and 100 days post-HSCT, 46 patients underwent computerized neuropsychological testing (CogState) and completed surveys assessing patient-reported cognitive complaints, emotional symptoms (depression, anxiety), sleep quality, daytime sleepiness, and physical and functional well-being. Correlations were calculated between cognitive complaints and neuropsychological performance (at each time-point and across time-points), as well as all other patient-reported variables. RESULTS: Patient-reported cognitive complaints were largely independent of concurrently assessed objective neuropsychological performance. Uniquely, our longitudinal data demonstrated significant medium to large effect size associations between subjective cognitive complaints post-HSCT with objectively measured change from pre-HSCT in attention, visual learning, and working memory (p < .05-.01). Subjective cognitive complaints post-HSCT were also associated with depression, anxiety, daytime sleepiness and physical well-being (p < .05-.001). CONCLUSIONS: Patients appear better able to assess their cognitive functioning relative to their own baseline and changes across time rather than relative to community norms. Thus, patient complaints of cognitive compromise justify further in-depth neuropsychological, emotional, and functional assessment. Future research into relationships between cognitive complaints and neuropsychological performance should account for changes in performance over time.


Asunto(s)
Disfunción Cognitiva/psicología , Trasplante de Células Madre Hematopoyéticas/psicología , Pruebas Neuropsicológicas , Calidad de Vida/psicología , Autoevaluación , Receptores de Trasplantes/psicología , Adulto , Ansiedad/psicología , Atención , Cognición/fisiología , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Masculino , Memoria a Corto Plazo/fisiología , Persona de Mediana Edad , Psicometría/métodos , Autoinforme , Encuestas y Cuestionarios
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