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1.
Emerg Med Clin North Am ; 39(2): 307-322, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33863461

RESUMEN

Chronic brain failure, also known as dementia or major neurocognitive disorder, is a syndrome of progressive functional decline characterized by both cognitive and neuropsychiatric symptoms. It can be conceptualized like other organ failure syndromes and its impact on quality of life can be mitigated with proper treatment. Dementia is a risk factor for delirium, and their symptoms can be similar. Patients with dementia can present with agitation that can lead to injury. Logic and reason are rarely successful when attempting to redirect someone with advanced dementia. Interactions that offer a sense of choice are more likely to succeed.


Asunto(s)
Demencia/diagnóstico , Trastornos Neurocognitivos/diagnóstico , Anciano , Antidepresivos/uso terapéutico , Antipsicóticos/uso terapéutico , Benzodiazepinas/uso terapéutico , Inhibidores de la Colinesterasa/uso terapéutico , Delirio/diagnóstico , Demencia/tratamiento farmacológico , Demencia/etiología , Diagnóstico Diferencial , Medicina de Emergencia , Humanos , Incidencia , Memantina/uso terapéutico , Competencia Mental , Trastornos Neurocognitivos/tratamiento farmacológico , Trastornos Neurocognitivos/etiología , Pruebas Neuropsicológicas , Dolor/diagnóstico , Prevalencia , Agitación Psicomotora/prevención & control
2.
Radiol Clin North Am ; 59(3): 425-440, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33926687

RESUMEN

Neurologic injury arises from treatment of central nervous system malignancies as result of direct toxic effects or indirect vascular, autoimmune, or infectious effects. Multimodality treatment may potentiate both therapeutic and toxic effects. Symptoms range from mild to severe and permanent. Injuries can be immediate or delayed. Many early complications are nonspecific. Other early and delayed neurologic injuries, such as posterior reversible encephalopathy syndrome, dural sinus thrombosis, infarctions, myelopathy, leukoencephalopathy, and hypophysitis, have unique imaging features. This article reviews treatment options for neurologic malignancies and common and uncommon neurologic injuries that can result from treatment, focusing on radiologic features.


Asunto(s)
Neoplasias Encefálicas/terapia , Diagnóstico por Imagen/métodos , Inmunoterapia/efectos adversos , Trastornos Neurocognitivos/diagnóstico , Trastornos Neurocognitivos/etiología , Traumatismos por Radiación/diagnóstico por imagen , Adulto , Encéfalo/diagnóstico por imagen , Niño , Terapia Combinada/efectos adversos , Humanos
3.
J Cancer Res Ther ; 16(6): 1215-1222, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33342776

RESUMEN

Introduction: Whole-brain radiation therapy (WBRT) is an effective therapeutic modality in patients with brain metastases. However, nearly 90% of patients undergoing WBRT suffer from a neurocognitive function (NCF) impairment at diagnosis, and up to two-thirds will experience a further decline within 2-6 months after WBRT. Focal-dose reduction on bilateral hippocampus is thought to improve NCF preservation. The aim was to present a systematic review of clinical results on NCF after hippocampal-sparing (HS) WBRT. Materials and Methods: A systematic review of published literature was performed on PubMed and the Cochrane Library. Only prospective clinical trials reporting NCF outcome in patients treated with HS-WBRT have been analyzed. Results: A total of 165 patients from three studies were included. These studies are characterized by small sample size and different methods in terms of WBRT technique but with similar planning analysis and NCF assessment tests. No significant changes in NCF (i.e., verbal and nonverbal learning memory, executive functions, and psychomotor speed) between baseline and 4-month follow-up after RT and only a mean relative decline in delayed recall at 4 months (7% compared to 30% of historical control) were observed. Conclusions: Considering preliminary results on NCF preservation, further studies seem justified in patients undergoing brain irradiation for brain metastases or referred for prophylactic cranial irradiation to evaluate long-term effects on NCF and quality of life.


Asunto(s)
Neoplasias Encefálicas/radioterapia , Hipocampo/efectos de la radiación , Trastornos Neurocognitivos/etiología , Traumatismos por Radiación/etiología , Irradiación Craneana/efectos adversos , Irradiación Craneana/métodos , Humanos , Trastornos Neurocognitivos/patología , Tratamientos Conservadores del Órgano/efectos adversos , Tratamientos Conservadores del Órgano/métodos , Pronóstico , Traumatismos por Radiación/patología
4.
Neurology ; 95(19): e2610-e2621, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-32887786

RESUMEN

OBJECTIVE: To characterize the prevalence and burden of HIV-associated neurocognitive disorder (HAND) and assess associated factors in the global population with HIV. METHODS: We searched PubMed and Embase for cross-sectional or cohort studies reporting the prevalence of HAND or its subtypes in HIV-infected adult populations from January 1, 1996, to May 15, 2020, without language restrictions. Two reviewers independently undertook the study selection, data extraction, and quality assessment. We estimated pooled prevalence of HAND by a random effects model and evaluated its overall burden worldwide. RESULTS: Of 5,588 records identified, we included 123 studies involving 35,513 participants from 32 countries. The overall prevalence of HAND was 42.6% (95% confidence interval [CI] 39.7-45.5) and did not differ with respect to diagnostic criteria used. The prevalence of asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia were 23.5% (20.3-26.8), 13.3% (10.6-16.3), and 5.0% (3.5-6.8) according to the Frascati criteria, respectively. The prevalence of HAND was significantly associated with the level of CD4 nadir, with a prevalence of HAND higher in low CD4 nadir groups (mean/median CD4 nadir <200 45.2% [40.5-49.9]) vs the high CD4 nadir group (mean/median CD4 nadir ≥200 37.1% [32.7-41.7]). Worldwide, we estimated that there were roughly 16,145,400 (95% CI 15,046,300-17,244,500) cases of HAND in HIV-infected adults, with 72% in sub-Saharan Africa (11,571,200 cases, 95% CI 9,600,000-13,568,000). CONCLUSIONS: Our findings suggest that people living with HIV have a high burden of HAND in the antiretroviral therapy (ART) era, especially in sub-Saharan Africa and Latin America. Earlier initiation of ART and sustained adherence to maintain a high-level CD4 cell count and prevent severe immunosuppression is likely to reduce the prevalence and severity of HAND.


Asunto(s)
Complejo SIDA Demencia/epidemiología , Disfunción Cognitiva/epidemiología , África del Sur del Sahara/epidemiología , Enfermedades Asintomáticas/epidemiología , Recuento de Linfocito CD4 , Disfunción Cognitiva/etiología , Salud Global , Infecciones por VIH/complicaciones , Humanos , América Latina/epidemiología , Trastornos Neurocognitivos/epidemiología , Trastornos Neurocognitivos/etiología , Prevalencia
5.
Psychol Aging ; 35(5): 639-653, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32744847

RESUMEN

Sometimes, we intentionally evaluate stimuli to assess whether we recognize them, whereas, at other times, stimuli automatically elicit recognition despite our efforts to ignore them. If multiple stimuli are encountered in the same environment, intentional recognition judgments can be biased by unintentional recognition of to-be-ignored stimuli. Aging is associated with increased distractibility and impaired intentional retrieval processes, which can make older adults more susceptible to distraction-induced recognition biases. We measured recognition memory performance, event-related potentials (ERPs), and electroencephalography oscillations in old (age range = 60-74) and young (age range = 18-24) adults to investigate how aging affects unintentional and intentional memory processes, and how these processes interact over time to produce distraction-induced recognition biases. Older participants had poorer intentional recognition memory, but the biasing effect of unintentional distractor recognition was similar across age groups. ERP effects related to intentional and unintentional recognition that were strongly expressed in the younger group were reduced or absent in the older group. Furthermore, the older group showed qualitatively different ERP activity during intentional recognition compared with the younger group. However, similar patterns of theta and alpha oscillations were found in both age groups, who showed theta power increases for both intentional and unintentional recognition, whereas alpha power was enhanced for intentional recognition but reduced for unintentional recognition. Overall, the findings show that unintentional and intentional recognition involve multiple dissociable memory processes that have different time-courses and functional characteristics and are differentially affected by aging. Whereas aging has strong effects on the neurocognitive mechanisms underlying intentional recognition memory, unintentional recognition mechanisms are less affected. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Envejecimiento/psicología , Trastornos Neurocognitivos/etiología , Reconocimiento en Psicología/fisiología , Anciano , Femenino , Humanos , Masculino
6.
Rev. neurol. (Ed. impr.) ; 71(1): 11-18, 1 jul., 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-195439

RESUMEN

INTRODUCCIÓN: El valor del potencial relacionado con eventos cognitivos P300 en el diagnóstico de los trastornos neurocognitivos subtipo Alzheimer es aún incipiente. Estudios recientes sugieren que su combinación con tests neuropsicológicos por dominios cognitivos permitiría caracterizar de forma objetiva y precoz el déficit cognitivo en sus etapas iniciales. OBJETIVO: Caracterizar los patrones electrofisiológicos en el potencial P300 que obtengan un valor discriminativo para el diagnóstico y clasificación de los trastornos neurocognitivos de etiología enfermedad de Alzheimer posible. Sujetos y métodos. Se estudia a 39 pacientes clasificados, según el DSM-5, con trastorno neurocognitivo menor y mayor debido a enfermedad de Alzheimer posible, en un rango de edad de 50-85 años, y a 53 sujetos control con funciones cognitivas normales. Se registra el potencial P300 en la modalidad auditiva, paradigma de oddball y registro centroparietal. RESULTADOS: La latencia P300 se prolonga significativamente en los sujetos con trastorno neurocognitivo; sus valores medios e intervalos de confianza son significativamente diferentes entre los controles sanos y los pacientes. No se obtienen diferencias significativas de latencia P300 entre los grupos con trastorno neurocognitivo menor y mayor. El valor medio de amplitud disminuye en el trastorno neurocognitivo, y el logaritmo de amplitud P300 obtiene valores medios e intervalos de confianza significativamente ciferentes entre los grupos control y con trastorno neurocognitivo menor y mayor. CONCLUSIONES: Los parámetros cuantificados en el potencial P300 pueden utilizarse como biomarcadores complementarios clasificadores de la presencia y del nivel de la disfunción cognitiva de etiología enfermedad de Alzheimer posible


INTRODUCTION: The value of the P300 cognitive event-related potential in the diagnosis of Alzheimer subtype neurocognitive disorders is still incipient. Recent studies suggest that combining it with neuropsychological tests by cognitive domains would allow an objective and early characterisation of the cognitive impairment in its initial stages. AIMS: To characterise the electrophysiological patterns in the P300 potential that obtain a discriminatory value for the diagnosis and classification of the neurocognitive disorders with a possible Alzheimer-type aetiology. SUBJECTS AND METHODS: This study examines 39 patients classified, according to the DSM-5, with possible Alzheimer-type minor and major neurocognitive disorders, aged between 50 and 85 years, and 53 control subjects with normal cognitive functions. The P300 potential is registered in the auditory mode, oddball paradigm and centroparietal recording. RESULTS: P300 latency is significantly prolonged in subjects with neurocognitive disorder; there are significant differences in the mean values and confidence intervals between healthy controls and patients. No significant differences are obtained in P300 latency between groups with minor and major neurocognitive disorder. The mean amplitude value decreases in neurocognitive disorder, and the P300 amplitude logarithm of the control groups and those with minor and major neurocognitive disorder reaches significantly different mean values and confidence intervals. CONCLUSIONS: The parameters quantified in the P300 potential can be used as complementary biomarkers to classify the presence and level of cognitive dysfunction with a possible Alzheimer-type aetiology


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Trastornos Neurocognitivos/clasificación , Trastornos Neurocognitivos/etiología , Enfermedad de Alzheimer/complicaciones , Potenciales Relacionados con Evento P300 , Electrofisiología/métodos , Pruebas Neuropsicológicas , Trastornos Neurocognitivos/diagnóstico , Estudios de Casos y Controles , Análisis de Varianza
7.
Crit Care ; 24(1): 76, 2020 03 04.
Artículo en Inglés | MEDLINE | ID: mdl-32131878

RESUMEN

BACKGROUND: Mechanical ventilation to alter and improve respiratory gases is a fundamental feature of critical care and intraoperative anesthesia management. The range of inspired O2 and expired CO2 during patient management can significantly deviate from values in the healthy awake state. It has long been appreciated that hyperoxia can have deleterious effects on organs, especially the lung and retina. Recent work shows intraoperative end-tidal (ET) CO2 management influences the incidence of perioperative neurocognitive disorder (POND). The interaction of O2 and CO2 on cerebral blood flow (CBF) and oxygenation with alterations common in the critical care and operating room environments has not been well studied. METHODS: We examine the effects of controlled alterations in both ET O2 and CO2 on cerebral blood flow (CBF) in awake adults using blood oxygenation level-dependent (BOLD) and pseudo-continuous arterial spin labeling (pCASL) MRI. Twelve healthy adults had BOLD and CBF responses measured to alterations in ET CO2 and O2 in various combinations commonly observed during anesthesia. RESULTS: Dynamic alterations in regional BOLD and CBF were seen in all subjects with expected and inverse brain voxel responses to both stimuli. These effects were incremental and rapid (within seconds). The most dramatic effects were seen with combined hyperoxia and hypocapnia. Inverse responses increased with age suggesting greater risk. CONCLUSIONS: Human CBF responds dramatically to alterations in ET gas tensions commonly seen during anesthesia and in critical care. Such alterations may contribute to delirium following surgery and under certain circumstances in the critical care environment. TRIAL REGISTRATION: ClincialTrials.gov NCT02126215 for some components of the study. First registered April 29, 2014.


Asunto(s)
Dióxido de Carbono/análisis , Imagen por Resonancia Magnética/métodos , Trastornos Neurocognitivos/etiología , Oxígeno/análisis , Adulto , Análisis de los Gases de la Sangre/métodos , Dióxido de Carbono/sangre , Femenino , Humanos , Hiperoxia/fisiopatología , Hipocapnia/fisiopatología , Imagen por Resonancia Magnética/tendencias , Masculino , Persona de Mediana Edad , Trastornos Neurocognitivos/sangre , Trastornos Neurocognitivos/fisiopatología , Oxígeno/sangre , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/fisiopatología
8.
Surgery ; 168(1): 147-154, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32178865

RESUMEN

BACKGROUND: Cardiopulmonary bypass may be associated with postoperative neurocognitive dysfunction; however, risk factors have not been clearly identified. We hypothesize that lower hematocrit levels are correlated with postoperative neurocognitive dysfunction. METHODS: A total of 30 patients underwent cardiac operations utilizing cardiopulmonary bypass and screening for neurocognitive dysfunction preoperatively and on postoperative day 4. Patients were analyzed according to hematocrit preoperatively, 6 hours postoperatively, and on postoperative day 4, and whether they received intra or postoperative transfusions of packed red blood cells. Neurocognitive data is presented as a difference in Repeatable Battery for the Assessment of Neuropsychological Status standardized score from baseline to postoperative day 4 and analyzed by unpaired two-tailed Spearman test and unpaired Mann-Whitney U test. RESULTS: There was a significant correlation between patients with lower hematocrit before surgery and a decline in neurocognitive function at postoperative day 4 (P < .05). All patients experienced a decrease in hematocrit during their hospital stay, but the hematocrit 6 hours postoperatively and postoperative day 4 did not impact cognition. Receiving a transfusion was also not associated with neurocognitive dysfunction. Patients with low hematocrit preoperatively had a consistently lower hematocrit throughout their stay. Prolonged total length of stay was also significantly associated with neurocognitive decline. CONCLUSION: A lower preoperative hematocrit and prolonged length of hospital stay are correlated with neurocognitive decline after cardiac surgery utilizing cardiopulmonary bypass.


Asunto(s)
Anemia/complicaciones , Puente Cardiopulmonar/efectos adversos , Trastornos Neurocognitivos/etiología , Complicaciones Posoperatorias/etiología , Anciano , Transfusión de Sangre Autóloga , Procedimientos Quirúrgicos Cardíacos , Femenino , Hematócrito , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos
9.
BMJ Case Rep ; 13(3)2020 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-32188609

RESUMEN

Glioblastoma multiforme (GBM) is the most common of the aggressive primary brain tumours arising in adults and has a dire prognosis. Neuropsychiatric symptoms can vary significantly among afflicted persons; psychiatric disturbances may be the predominant presenting symptoms. Distinguishing between functional psychiatric disorders, particularly depression, from other subtle neuropsychiatric disturbances that may accompany GBM can be challenging. The authors present a clinical case and review of the literature in an attempt to highlight the special considerations that should be taken into account when evaluating patients who present with late-onset or atypical symptoms, refractory psychiatric symptoms, or subtle neurological disturbances signalling the need for diagnostic assessment, particularly neuroimaging, for the presence of a tumour. Early diagnosis is critical for improvement in quality of life.


Asunto(s)
Neoplasias Encefálicas/diagnóstico , Glioblastoma/diagnóstico , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/psicología , Trastorno Depresivo/diagnóstico , Diagnóstico Diferencial , Glioblastoma/complicaciones , Glioblastoma/diagnóstico por imagen , Glioblastoma/psicología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Trastornos Neurocognitivos/etiología
10.
BMJ Case Rep ; 13(3)2020 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-32188610

RESUMEN

A 56-year-old man was brought to our hospital by his family, seeking medical treatment for the patient's long-standing progressive word-finding difficulties, forgetfulness, agitation and social withdrawal. After multiple previous physician consultations, the patient was mistakenly diagnosed with epilepsy and prescribed multiple anticonvulsants, to which his above mentioned symptoms were unresponsive. His condition progressed over the next 10 years, resulting in severe cognitive impairments and a complete dysfunctionality. An electroencephalogram (EEG) assessment revealed persistent spike and wave activity in the left temporal lobe. Brain MRI revealed multiple small bright T2 and fluid attenuated inversion recovery (FLAIR) foci within the white matter of both cerebral hemispheres surrounding the ventricular system, as well as some widening of extra-axial cerebrospinal fluid spaces. The patient was finally diagnosed with early-onset dementia and temporal lobe epileptiform abnormalities. This case emphasises the need for diagnostic consideration of dementia in cognitively impaired patients, even when they are not of an advanced age.


Asunto(s)
Demencia/diagnóstico , Demencia/complicaciones , Demencia/diagnóstico por imagen , Diagnóstico Diferencial , Electroencefalografía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Trastornos Neurocognitivos/etiología
11.
PLoS One ; 15(3): e0230563, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32210470

RESUMEN

Despite antiretroviral therapy human immunodeficiency virus type-1 (HIV-1) infection results in neuroinflammation of the central nervous system that can cause HIV-associated neurocognitive disorders (HAND). The molecular mechanisms involved in the development of HAND are unclear, however, they are likely due to both direct and indirect consequences of HIV-1 infection and inflammation of the central nervous system. Additionally, opioid abuse in infected individuals has the potential to exacerbate HIV-comorbidities, such as HAND. Although restricted for productive HIV replication, astrocytes (comprising 40-70% of all brain cells) likely play a significant role in neuropathogenesis in infected individuals due to the production and response of viral proteins. The HIV-1 protein Tat is critical for viral transcription, causes neuroinflammation, and can be secreted from infected cells to affect uninfected bystander cells. The Wnt/ß-catenin signaling cascade plays an integral role in restricting HIV-1 infection in part by negatively regulating HIV-1 Tat function. Conversely, Tat can overcome this negative regulation and inhibit ß-catenin signaling by sequestering the critical transcription factor TCF-4 from binding to ß-catenin. Here, we aimed to explore how opiate exposure affects Tat-mediated suppression of ß-catenin in astrocytes and the downstream modulation of neuroinflammatory genes. We observed that morphine can potentiate Tat suppression of ß-catenin activity in human astrocytes. In contrast, Tat mutants deficient in secretion, and lacking neurotoxic effects, do not affect ß-catenin activity in the presence or absence of morphine. Finally, morphine treatment of astrocytes was sufficient to reduce the expression of genes involved in neuroinflammation. Examining the molecular mechanisms of how HIV-1 infection and opiate exposure exacerbate neuroinflammation may help us inform or predict disease progression prior to HAND development.


Asunto(s)
Analgésicos Opioides/efectos adversos , Infecciones por VIH/complicaciones , VIH-1/efectos de los fármacos , Morfina/efectos adversos , Trastornos Neurocognitivos/etiología , Trastornos Relacionados con Sustancias/complicaciones , Productos del Gen tat del Virus de la Inmunodeficiencia Humana/inmunología , Astrocitos/efectos de los fármacos , Astrocitos/inmunología , Astrocitos/virología , Línea Celular , Células Cultivadas , Infecciones por VIH/inmunología , Infecciones por VIH/virología , VIH-1/inmunología , Humanos , Trastornos Neurocognitivos/inmunología , Trastornos Neurocognitivos/virología , Trastornos Relacionados con Sustancias/inmunología , beta Catenina/inmunología
12.
J Med Case Rep ; 14(1): 28, 2020 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-32046774

RESUMEN

BACKGROUND: Agenesis of the corpus callosum can occur isolated or as part of a complex congenital syndrome. Patients with isolated agenesis of the corpus callosum may present with severe intellectual disability, although a proportion of affected individuals develop normal intelligence. However, even in patients with no apparent deficits, subtle neuropsychological alterations may occur as the cognitive demand increases with age. Hence, patients with this deffect require a strict follow-up during their postnatal life. Thus, physicians require a better knowledge of the cognitive features of agenesis of the corpus callosum to improve their approach to this cerebral malformation. Here, we report an illustrative case of a school-age child with isolated agenesis of the corpus callosum and normal intelligence. We also provide a literature review about the postnatal screening of neurocognitive deficits in patients with agenesis of the corpus callosum. CASE PRESENTATION: An 8-year-old Hispanic boy with total agenesis of the corpus callosum attended for medical follow-up. The defect was identified during the neonatal period by cranial ultrasonography and brain computed tomography scan. However, he did not present any craniofacial or non-cerebral malformation suggestive of a congenital syndrome. Furthermore, he showed no neuropsychiatric disorder or intellectual disability during his early childhood. At the age of 4, he was subjected to a control brain magnetic resonance imaging that showed total agenesis of the corpus callosum and colpocephaly. At his arrival, a neurological examination was normal with no signs of intracranial hypertension. His intelligence quotient was unaltered and he scored normal in the Mini-Mental State Examination test. The literature reviewed here suggested that patients with agenesis of the corpus callosum require a strict neurocognitive follow-up during postnatal life, as they may present neuropsychological deficits during adolescence, when development of the corpus callosum is completed and there is maximum reliance on this structure. Thus, our patient was scheduled for future annual neurocognitive testing. CONCLUSIONS: Isolated agenesis of the corpus callosum is not innocuous, and patients with this defect require a strict neurocognitive follow-up. We provide an informative reference tool useful for the postnatal neuropsychological screening of patients with isolated agenesis of the corpus callosum.


Asunto(s)
Agenesia del Cuerpo Calloso/diagnóstico por imagen , Inteligencia , Agenesia del Cuerpo Calloso/complicaciones , Agenesia del Cuerpo Calloso/patología , Niño , Humanos , Discapacidad Intelectual/diagnóstico , Discapacidad Intelectual/etiología , Masculino , Trastornos Neurocognitivos/diagnóstico , Trastornos Neurocognitivos/etiología , Tomografía Computarizada por Rayos X , Ultrasonografía
13.
Int J Mol Sci ; 21(3)2020 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-32046097

RESUMEN

Cognitive symptoms are prevalent in the elderly and are associated with an elevated risk of developing dementia. Disease-driven changes can cause cognitive disabilities in memory, attention, and language. The inflammasome is an innate immune intracellular complex that has a critical role in the host defense system, in that it senses infectious pathogen-associated and endogenous danger-associated molecular patterns. An unbalanced or dysregulated inflammasome is associated with infectious, inflammatory, and neurodegenerative diseases. Due to its importance in such pathological conditions, the inflammasome is an emerging drug target for human diseases. A growing number of studies have revealed links between cognitive symptoms and the inflammasome. Several studies have shown that reducing the inflammasome component mitigates cognitive symptoms in diseased states. Therefore, understanding the inflammasome regulatory mechanisms may be required for the prevention and treatment of cognitive symptoms. The purpose of this review is to discuss the current understanding of the inflammasome and its relationships with cognitive symptoms in various human diseases.


Asunto(s)
Inflamasomas/metabolismo , Trastornos Neurocognitivos/metabolismo , Sepsis/complicaciones , Animales , Apoptosis , Humanos , Interleucinas/genética , Interleucinas/metabolismo , Trastornos Neurocognitivos/etiología
15.
Cancer Metastasis Rev ; 39(1): 27-41, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31965433

RESUMEN

Childhood cancer survivors are at higher risk of developing neurocognitive deficits due to the intensive treatment they received at an early age. Most studies on childhood cancer survivorship have so far focused on the Western populations. Due to the ethnic, genetic, environmental, and cultural differences, clinical data of the Western populations may not be representative of Asian countries. This scoping review systematically summarized the existing clinical evidence of the neurocognitive impairment of Asian childhood cancer survivors. We searched the Embase and Medline databases for studies assessing the neurocognitive functions of survivors in Asia, who were diagnosed with cancer before the age of 19 and completed active treatment. The literature search identified 13 studies involving 2212 participants from five Asian countries: South Korea (n = 4, 30.8%), Taiwan (n = 3, 23.1%), Japan (n = 3, 23.1%), Hong Kong (n = 2, 15.4%), and Thailand (n = 1, 7.7%). The included studies focused on CNS tumors (n = 10, 76.9%), hematological malignancies (n = 7, 53.8%), or heterogeneous cancer diagnoses (n = 3, 23.1%). Collectively, mild-to-moderate impairment in intelligence was observed in 10.0 to 42.8% of survivors, which seemed higher than the reported rate in Western survivors. We speculate that the ethnic and genetic variations in drug responses and susceptibility to adverse chronic toxicities may have contributed to the differences in the prevalence and severity of neurocognitive impairment between these two populations. To better understand the effects of culturally relevant and region-specific environmental risk factors on the post-treatment neurocognitive development in cancer survivors, a holistic approach that addresses the complex interactions between biological, physical, and psychosocial factors is needed. This will aid the development of effective intervention strategies to improve the functional and psychosocial outcomes of cancer survivors in Asian societies.


Asunto(s)
Supervivientes de Cáncer/estadística & datos numéricos , Neoplasias/epidemiología , Trastornos Neurocognitivos/epidemiología , Asia/epidemiología , Niño , Humanos , Neoplasias/terapia , Trastornos Neurocognitivos/etiología
16.
Am J Addict ; 29(2): 120-128, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31951069

RESUMEN

BACKGROUND AND OBJECTIVES: Chronic opioid exposure has been linked with neurocognitive impairments. Evidence of residual impairment with cannabis use is less consistent. We investigated whether patients with opioid and cannabis dependence perform poorly compared with those with opioid dependence alone. METHODS: We recruited three groups of participants aged 18 to 55 years: opioid and cannabis dependence (OCaD; n = 21), only opioid dependence (OD; n = 19), and a control group (HC; n = 20). Subjects with other substance use, human immunodeficiency virus, head injury, epilepsy, and severe mental illness were excluded. Cognitive tests, performed after at least 1 week of abstinence, consisted of the Wisconsin card sorting test (WCST), Iowa gambling task (IGT), trail making tests A and B (TMT-A and B), verbal and visual N-back test (NBT), and standard progressive matrices for intelligence quotient (IQ). The general linear model was used to compare the groups with age and years of education as covariates. RESULTS: IQ and severity of opioid dependence were comparable in the three groups. The mean duration of cannabis use was 76.2 (±39.4) months. Compared with the HC, both OD and OCaD had significant impairment on the IGT, WCST, TMTs, and NBT. No significant group difference was observed between the OD and OCaD groups. DISCUSSION AND CONCLUSIONS: Opioid dependence is associated with impairments in decision making, executive function, working memory, and attention. Co-morbid cannabis dependence had similar profiles of cognitive impairments. SCIENTIFIC SIGNIFICANCE: Co-morbid cannabis dependence might not add on to the existing cognitive dysfunction in opioid dependence. Further studies should be done with a larger sample. (Am J Addict 2020;29:120-128).


Asunto(s)
Abuso de Marihuana/psicología , Trastornos Neurocognitivos/etiología , Trastornos Relacionados con Opioides/psicología , Adolescente , Adulto , Estudios de Casos y Controles , Enfermedad Crónica , Estudios Transversales , Femenino , Humanos , Modelos Lineales , Masculino , Abuso de Marihuana/complicaciones , Persona de Mediana Edad , Trastornos Neurocognitivos/diagnóstico , Pruebas Neuropsicológicas , Trastornos Relacionados con Opioides/complicaciones , Adulto Joven
17.
Nutrients ; 12(1)2020 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-31947964

RESUMEN

Preterm infants have altered body composition compared to term infants, which impacts both neurodevelopment and metabolic health, but whether increased dietary intake during hospitalization, independent of illness, may improve body composition is unknown. This prospective, longitudinal study (n = 103) measured fat-free mass (FFM) and percent body fat (%BF) at discharge and four months corrected age for prematurity (CA) in very low birth weight (VLBW) preterm infants. Markers of illness and macronutrient intakes (protein and caloric) were recorded. Bayley Scales of Infant Development-III (BSID) were administered at 12 and 24 months of age in a subset of these infants (n = 66 and n = 50 respectively). Body composition z-scores were calculated using recently developed reference curves. Linear regression was used to test the associations between clinical factors and body composition z-scores, as well as z-scores and BSID scores. Increased calories and protein received in the first week after birth and protein intake throughout hospitalization were associated with increased FFM z-scores at discharge, but not with %BF z-scores. After adjustment for both early acute and chronic illness, associations of nutrient intake with FFM z-score remained unchanged. FFM z-scores at discharge were positively associated with scores on the BSID at 12 and 24 months CA. In conclusion, increased energy and protein intakes both early in hospitalization and across its entire duration are associated with higher FFM at discharge, a key marker for organ growth and neurodevelopment in the VLBW neonate. Optimizing caloric intake, irrespective of illness is critical for enhancing body composition, and by extension, neurodevelopmental outcomes for preterm infants.


Asunto(s)
Composición Corporal/fisiología , Desarrollo Infantil/fisiología , Recien Nacido Prematuro/crecimiento & desarrollo , Recién Nacido de muy Bajo Peso/crecimiento & desarrollo , Apoyo Nutricional/métodos , Tejido Adiposo/crecimiento & desarrollo , Índice de Masa Corporal , Ingestión de Energía , Femenino , Edad Gestacional , Hospitalización , Humanos , Lactante , Fenómenos Fisiológicos Nutricionales del Lactante , Recién Nacido , Modelos Lineales , Estudios Longitudinales , Masculino , Trastornos Neurocognitivos/etiología , Estado Nutricional , Estudios Prospectivos
18.
J Surg Oncol ; 121(4): 676-687, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31930514

RESUMEN

BACKGROUND: The proposed underlying mechanisms of anxiety and depression, and of postoperative neurocognitive disorder (NCD), each include immune system involvement. Therefore, the aims of this study were to investigate the incidence of postoperative NCD 3 months after surgery among oncological patients undergoing surgery and to evaluate the role of preoperative anxiety and depression. METHOD: A consecutive series of patients (age ≥ 18 years) undergoing surgery for the removal of solid tumors were included (n = 218). Cognitive performance was assessed preoperatively and at 3 months postoperatively. Preoperative anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. RESULTS: NCD affected 12.3% of elderly patients (age ≥ 70 years, n = 57) at 3 months after surgery, with executive function mostly affected. By contrast, 8.4% of younger patients (age < 70 years, n = 107) were affected, with information processing speed mostly affected. Low educational attainment was a risk factor (OR, 6.0; 95% CI, 1.9-19.0) of overall NCD, whereas preoperative anxiety was associated with decline in the domain of executive function. CONCLUSION: Postoperative NCD is a complication of oncological surgery for all adults instead of the elderly only. Preoperative anxiety was associated with an increased risk of executive function decline, and low educational attainment was a key factor for overall NCD.


Asunto(s)
Ansiedad/etiología , Depresión/etiología , Neoplasias/cirugía , Trastornos Neurocognitivos/etiología , Factores de Edad , Anciano , Procedimientos Quirúrgicos de Citorreducción/efectos adversos , Procedimientos Quirúrgicos de Citorreducción/psicología , Femenino , Humanos , Masculino , Neoplasias/psicología , Periodo Posoperatorio , Periodo Preoperatorio , Estudios Prospectivos
19.
J Neurooncol ; 146(1): 147-156, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31782051

RESUMEN

PURPOSE: Survivors of pediatric embryonal brain tumors (BT) are at high risk for sensorineural hearing loss (SNHL) associated with neurocognitive decline. However, previous studies have not assessed the relationship between SNHL and adaptive functioning. We examined neurocognitive and adaptive functioning in patients with and without SNHL. METHODS: Participants included 36 patients treated for an embryonal BT with craniospinal irradiation (CSI) and cisplatin chemotherapy who were assessed 6.7 years post-treatment on average. The impact of SNHL on neurocognitive performance and parent-rated adaptive functioning was assessed in univariate and multivariate analyses. RESULTS: There were 17 cases with SNHL (mean age at evaluation = 14.4) and 19 cases with NH (mean age at evaluation = 13.8). After accounting for age at diagnosis and additional covariates in multivariable analyses, SNHL was associated with worse overall intellectual functioning (p = 0.027) and perceptual reasoning (p = 0.016) performance. There was no effect of SNHL on adaptive functioning in multivariable models. Age at diagnosis and sex were associated with performance on neurocognitive measures. CONCLUSIONS: SNHL in pediatric embryonal BT is associated with increased risk for neurocognitive deficits in conjunction with other demographic and treatment-related factors.


Asunto(s)
Adaptación Psicológica , Neoplasias Encefálicas/terapia , Supervivientes de Cáncer/estadística & datos numéricos , Cisplatino/efectos adversos , Irradiación Craneoespinal/efectos adversos , Pérdida Auditiva Sensorineural/fisiopatología , Trastornos Neurocognitivos/etiología , Adolescente , Adulto , Antineoplásicos/efectos adversos , Neoplasias Encefálicas/patología , Supervivientes de Cáncer/psicología , Niño , Preescolar , Terapia Combinada , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trastornos Neurocognitivos/patología , Pronóstico , Adulto Joven
20.
J Neurooncol ; 146(1): 97-109, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31802314

RESUMEN

PURPOSE: Deficits in neurocognitive functioning (NCF) frequently occur in glioma patients. Both treatment and the tumor itself contribute to these deficits. In order to minimize the harmful effects of surgery, an increasing number of patients undergo awake craniotomy. To investigate whether we can indeed preserve cognitive functioning after state-of-the art awake surgery and to identify factors determining postoperative NCF, we performed a retrospective cohort study. METHODS: In diffuse glioma (WHO grade 2-4) patients undergoing awake craniotomy, we studied neurocognitive functioning both pre-operatively and 3-6 months postoperatively. Evaluation covered five neurocognitive domains. We performed analysis of data on group and individual level and evaluated the value of patient-, tumor- and treatment-related factors for predicting change in NCF, using linear and logistic regression analysis. RESULTS: We included 168 consecutive patients. Mean NCF-scores of psychomotor speed and visuospatial functioning significantly deteriorated after surgery. The percentage of serious neurocognitive impairments (- 2 standard deviations) increased significantly for psychomotor speed only. Tumor involvement in the left thalamus predicted a postoperative decline in NCF for the domains overall-NCF, executive functioning and psychomotor speed. An IDH-wildtype status predicted decline for overall-NCF and executive functioning. CONCLUSIONS: In all cognitive domains, except for psychomotor speed, cognitive functioning can be preserved after awake surgery. The domain of psychomotor speed seems to be most vulnerable to the effects of surgery and early postoperative therapies. Cognitive performance after glioma surgery is associated with a combination of structural and biomolecular effects from the tumor, including IDH-status and left thalamic involvement.


Asunto(s)
Neoplasias Encefálicas/cirugía , Craneotomía/efectos adversos , Glioma/cirugía , Trastornos Neurocognitivos/etiología , Complicaciones Posoperatorias , Neoplasias Encefálicas/patología , Función Ejecutiva , Femenino , Estudios de Seguimiento , Glioma/patología , Humanos , Masculino , Trastornos Neurocognitivos/patología , Pruebas Neuropsicológicas , Pronóstico , Estudios Retrospectivos , Vigilia
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