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1.
Medicine (Baltimore) ; 100(32): e26914, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397930

RESUMO

ABSTRACT: Atrial fibrillation is considered to be the most common arrhythmia in the clinic, and it gradually increases with age. In recent years, there has been increasing evidence that atrial fibrillation may exacerbate the progression of cognitive dysfunction. The current guidelines recommend ablation for drug-refractory atrial fibrillation.We aimed to prospectively analyze changes in cognitive function in patients with atrial fibrillation following treatment using different ablation methods.A total of 139 patients, with non-valvular atrial fibrillation, were included in the study. The patients were divided into the drug therapy (n = 41) and catheter ablation (n = 98) groups, with the catheter ablation group further subdivided into radiofrequency ablation (n = 68) and cryoballoon (CY) ablation (n = 30). We evaluated cognitive function at baseline, 3- and 12-months follow-up using the Telephone Interview for Cognitive Status-modified (TICS-m) test, then analyzed differences in cognitive function between the drug therapy and catheter ablation groups, to reveal the effect of the different ablation methods.We observed a significantly higher TICS-m score (39.56 ±â€Š3.198) in the catheter ablation group at 12-month follow-up (P < .001), than the drug treatment group was. Additionally, we found no statistically significant differences in TICS-m scores between the radiofrequency ablation and CY groups at 3- and 12-month postoperatively (P > .05), although the two subgroups showed statistically significant cognitive function (P < .001).Overall, these findings indicated that radiofrequency and CY ablation improve cognitive function in patients with atrial fibrillation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Cognição/fisiologia , Disfunção Cognitiva/etiologia , Criocirurgia/métodos , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Feminino , Seguimentos , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
2.
Nat Commun ; 12(1): 4672, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344864

RESUMO

Circadian rhythms have natural relative variations among humans known as chronotype. Chronotype or being a morning or evening person, has a specific physiological, behavioural, and also genetic manifestation. Whether and how chronotype modulates human brain physiology and cognition is, however, not well understood. Here we examine how cortical excitability, neuroplasticity, and cognition are associated with chronotype in early and late chronotype individuals. We monitor motor cortical excitability, brain stimulation-induced neuroplasticity, and examine motor learning and cognitive functions at circadian-preferred and non-preferred times of day in 32 individuals. Motor learning and cognitive performance (working memory, and attention) along with their electrophysiological components are significantly enhanced at the circadian-preferred, compared to the non-preferred time. This outperformance is associated with enhanced cortical excitability (prominent cortical facilitation, diminished cortical inhibition), and long-term potentiation/depression-like plasticity. Our data show convergent findings of how chronotype can modulate human brain functions from basic physiological mechanisms to behaviour and higher-order cognition.


Assuntos
Encéfalo/fisiologia , Ritmo Circadiano/fisiologia , Cognição/fisiologia , Adulto , Atenção/fisiologia , Comportamento/fisiologia , Excitabilidade Cortical , Feminino , Humanos , Aprendizagem/fisiologia , Masculino , Memória de Curto Prazo/fisiologia , Plasticidade Neuronal , Sono/fisiologia , Estimulação Magnética Transcraniana , Adulto Jovem
3.
Neurobiol Aging ; 106: 80-94, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34256190

RESUMO

Healthy aging is accompanied by reduced cognitive control and widespread alterations in the underlying brain networks; but the extent to which large-scale functional networks in older age show reduced specificity across different domains of cognitive control is unclear. Here we use cov-STATIS (a multi-table multivariate technique) to examine similarity of functional connectivity during different domains of cognitive control-inhibition, initiation, shifting, and working memory-across the adult lifespan. We report two major findings: (1) Functional connectivity patterns during initiation, inhibition, and shifting were more similar in older ages, particularly for control and default networks, a pattern consistent with dedifferentiation of the neural correlates associated with cognitive control; and (2) Networks exhibited age-related reconfiguration such that frontal, default, and dorsal attention networks were more integrated whereas sub-networks of somato-motor system were more segregated in older age. Together these findings offer new evidence for dedifferentiation and reconfiguration of functional connectivity underlying different aspects of cognitive control in normal aging.


Assuntos
Encéfalo/fisiologia , Desdiferenciação Celular/fisiologia , Cognição/fisiologia , Envelhecimento Saudável/fisiologia , Longevidade/fisiologia , Rede Nervosa/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Envelhecimento/psicologia , Encéfalo/diagnóstico por imagem , Feminino , Envelhecimento Saudável/psicologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Rede Nervosa/diagnóstico por imagem , Desempenho Psicomotor/fisiologia , Adulto Jovem
4.
Curr Opin Psychiatry ; 34(5): 467-476, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34292182

RESUMO

PURPOSE OF REVIEW: Cognitive behavioral therapy (CBT) with exposure and response prevention is the first-line treatment for obsessive-compulsive disorder (OCD) and related disorders such as body dysmorphic disorder (BDD). We review here recent developments in CBT and related therapies in treating OCD and related disorders. RECENT FINDINGS: Superiority of CBT over medications in treating OCD is being questioned by some recent meta-analyses, nonetheless CBT continues to be the mainstay of treatment. Web-based therapies have been shown to be beneficial in treating at least mild-to-moderately ill patients. Mindfulness-based CBT, intensive residential treatment and Bergen 4-day concentrated exposure are also proving to be useful in treating OCD. Large well designed studies have demonstrated the efficacy CBT over supportive therapy in treating BDD. Research on the efficacy of CBT in treating hoarding disorder is accumulating. SUMMARY: Efficacy of web-based CBT has a potential public health importance in that CBT may now become accessible to all and benefit at least mild-to-moderately ill patients who form most of the clinically ill sample. Similarly, efficacy of Bergen 4-day concentrated exposure will have a huge public health implication if the findings can be replicated in other centers across the world.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Atenção Plena , Transtorno Obsessivo-Compulsivo/terapia , Cognição/fisiologia , Humanos , Resultado do Tratamento
5.
Neuron ; 109(16): 2590-2603.e13, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34197733

RESUMO

Neuropsychiatric disorders are often accompanied by cognitive impairments/intellectual disability (ID). It is not clear whether there are converging mechanisms underlying these debilitating impairments. We found that many autism and schizophrenia risk genes are expressed in the anterodorsal subdivision (AD) of anterior thalamic nuclei, which has reciprocal connectivity with learning and memory structures. CRISPR-Cas9 knockdown of multiple risk genes selectively in AD thalamus led to memory deficits. While the AD is necessary for contextual memory encoding, the neighboring anteroventral subdivision (AV) regulates memory specificity. These distinct functions of AD and AV are mediated through their projections to retrosplenial cortex, using differential mechanisms. Furthermore, knockdown of autism and schizophrenia risk genes PTCHD1, YWHAG, or HERC1 from AD led to neuronal hyperexcitability, and normalization of hyperexcitability rescued memory deficits in these models. This study identifies converging cellular to circuit mechanisms underlying cognitive deficits in a subset of neuropsychiatric disease models.


Assuntos
Núcleos Anteriores do Tálamo/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Vias Neurais/fisiopatologia , Núcleos Talâmicos/fisiopatologia , Animais , Núcleos Anteriores do Tálamo/fisiologia , Córtex Cerebral/fisiopatologia , Cognição/fisiologia , Camundongos , Vias Neurais/fisiologia , Núcleos Talâmicos/fisiologia
6.
Clin Geriatr Med ; 37(3): 457-467, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34210450

RESUMO

There is a strong association between obstructive sleep apnea (OSA) and cognitive dysfunction. Executive function, attention, verbal/visual long-term memory, visuospatial/constructional ability, and information processing are more likely to be affected, whereas language, psychomotor function, and short-term memory are less likely to be affected. Increased accumulation of Aß2-amyloid in the brain, episodic hypoxemia, oxidative stress, vascular inflammation, and systemic comorbidities may contribute to the pathogenesis. Patients with OSA should have cognitive screening or formal testing, and patients with cognitive decline should have testing for OSA. Treatment with continuous positive airway pressure may improve cognitive symptoms in the patient with OSA.


Assuntos
Transtornos Cognitivos/fisiopatologia , Cognição/fisiologia , Disfunção Cognitiva/etiologia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Apneia Obstrutiva do Sono/terapia , Idoso , Função Executiva , Humanos , Apneia Obstrutiva do Sono/psicologia
7.
Nat Commun ; 12(1): 4216, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34244490

RESUMO

The formation of large-scale brain networks, and their continual refinement, represent crucial developmental processes that can drive individual differences in cognition and which are associated with multiple neurodevelopmental conditions. But how does this organization arise, and what mechanisms drive diversity in organization? We use generative network modeling to provide a computational framework for understanding neurodevelopmental diversity. Within this framework macroscopic brain organization, complete with spatial embedding of its organization, is an emergent property of a generative wiring equation that optimizes its connectivity by renegotiating its biological costs and topological values continuously over time. The rules that govern these iterative wiring properties are controlled by a set of tightly framed parameters, with subtle differences in these parameters steering network growth towards different neurodiverse outcomes. Regional expression of genes associated with the simulations converge on biological processes and cellular components predominantly involved in synaptic signaling, neuronal projection, catabolic intracellular processes and protein transport. Together, this provides a unifying computational framework for conceptualizing the mechanisms and diversity in neurodevelopment, capable of integrating different levels of analysis-from genes to cognition.


Assuntos
Encéfalo/crescimento & desenvolvimento , Cognição/fisiologia , Modelos Neurológicos , Rede Nervosa/crescimento & desenvolvimento , Neurogênese/fisiologia , Adolescente , Encéfalo/diagnóstico por imagem , Criança , Desenvolvimento Infantil/fisiologia , Estudos de Coortes , Simulação por Computador , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Rede Nervosa/diagnóstico por imagem
8.
Nutrients ; 13(6)2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34200678

RESUMO

Food homeostatic states (hunger and satiety) influence the cognitive systems regulating impulsive responses, but the direction and specific mechanisms involved in this effect remain elusive. We examined how fasting, and satiety, affect cognitive mechanisms underpinning disinhibition using a novel framework and a gamified test-battery. Thirty-four participants completed the test-battery measuring three cognitive facets of disinhibition: attentional control, information gathering and monitoring of feedback, across two experimental sessions: one after overnight fasting and another after a standardised meal. Homeostatic state was assessed using subjective self-reports and biological markers (i.e., blood-derived liver-expressed antimicrobial protein 2 (LEAP-2), insulin and leptin). We found that participants who experienced greater subjective hunger during the satiety session were more impulsive in the information gathering task; results were not confounded by changes in mood or anxiety. Homeostatic state did not significantly influence disinhibition mechanisms linked to attentional control or feedback monitoring. However, we found a significant interaction between homeostatic state and LEAP-2 on attentional control, with higher LEAP-2 associated with faster reaction times in the fasted condition only. Our findings indicate lingering hunger after eating increases impulsive behaviour via reduced information gathering. These findings identify a novel mechanism that may underpin the tendency to overeat and/or engage in broader impulsive behaviours.


Assuntos
Cognição/fisiologia , Homeostase , Fome/fisiologia , Testes Neuropsicológicos , Adolescente , Adulto , Peptídeos Catiônicos Antimicrobianos/metabolismo , Apetite/fisiologia , Atenção/fisiologia , Proteínas Sanguíneas/metabolismo , Tomada de Decisões , Retroalimentação , Feminino , Hormônios/metabolismo , Humanos , Masculino , Saciação , Adulto Jovem
9.
Aging (Albany NY) ; 13(13): 17080-17096, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34232918

RESUMO

Emerging evidence suggests that olfactory function is closely linked to memory function. The aims of this study were to assess whether olfactory and episodic memory functions follow similar age-related decline trajectories, to identify different patterns of decline, as well as predictors of the patterns. 1023 participants from the Memory and Aging Project were followed for up to 8 years with annual episodic memory and odor identification assessments. Trajectories were modelled using growth mixture models. Multivariate logistic regression was used to identify pattern predictors. Three patterns of joint trajectories were identified; Class 1- stable average performance in both functions (n=690, 67.4%); Class 2- stable average episodic memory and declining odor identification (n=231, 22.6%); and Class 3- decline in both functions (n= 102, 10.0%). Class predictors included age, sex, APOE ε4 status, cognitive activity level and BMI. Participants in Class 3 were most likely to develop dementia. Episodic memory and olfactory function show similar trajectories in aging. Such classification can contribute to a better understanding of the factors related to cognitive decline and dementia.


Assuntos
Envelhecimento/fisiologia , Memória Episódica , Desempenho Psicomotor/fisiologia , Olfato/fisiologia , Idoso , Idoso de 80 Anos ou mais , Apolipoproteína E4/genética , Índice de Massa Corporal , Cognição/fisiologia , Disfunção Cognitiva , Escolaridade , Exercício Físico , Feminino , Humanos , Estudos Longitudinais , Masculino , Odorantes , Caracteres Sexuais , Comportamento Social , Classe Social
11.
Nutrients ; 13(6)2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34205336

RESUMO

Emerging evidence indicates that gut microbiota is important in the regulation of brain activity and cognitive functions. Microbes mediate communication among the metabolic, peripheral immune, and central nervous systems via the microbiota-gut-brain axis. However, it is not well understood how the gut microbiome and neurons in the brain mutually interact or how these interactions affect normal brain functioning and cognition. We summarize the mechanisms whereby the gut microbiota regulate the production, transportation, and functioning of neurotransmitters. We also discuss how microbiome dysbiosis affects cognitive function, especially in neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease.


Assuntos
Cognição/fisiologia , Microbioma Gastrointestinal/fisiologia , Doenças Neurodegenerativas/microbiologia , Neurotransmissores/fisiologia , Doença de Alzheimer/microbiologia , Animais , Ansiedade/microbiologia , Transtorno do Espectro Autista/microbiologia , Encéfalo/fisiopatologia , Depressão/microbiologia , Disbiose/fisiopatologia , Humanos , Doença de Parkinson/microbiologia , Esquizofrenia/microbiologia
12.
Am J Psychiatry ; 178(8): 701-714, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34080889

RESUMO

Although rodent research provides important insights into neural correlates of human psychology, new cortical areas, connections, and cognitive abilities emerged during primate evolution, including human evolution. Comparison of human brains with those of nonhuman primates reveals two aspects of human brain evolution particularly relevant to emotional disorders: expansion of homotypical association areas and expansion of the hippocampus. Two uniquely human cognitive capacities link these phylogenetic developments with emotion: a subjective sense of participating in and reexperiencing remembered events and a limitless capacity to imagine details of future events. These abilities provided evolving humans with selective advantages, but they also created proclivities for emotional problems. The first capacity evokes the "reliving" of past events in the "here-and-now," accompanied by emotional responses that occurred during memory encoding. It contributes to risk for stress-related syndromes, such as posttraumatic stress disorder. The second capacity, an ability to imagine future events without temporal limitations, facilitates flexible, goal-related behavior by drawing on and creating a uniquely rich array of mental representations. It promotes goal achievement and reduces errors, but the mental construction of future events also contributes to developmental aspects of anxiety and mood disorders. With maturation of homotypical association areas, the concrete concerns of childhood expand to encompass the abstract apprehensions of adolescence and adulthood. These cognitive capacities and their dysfunction are amenable to a research agenda that melds experimental therapeutic interventions, cognitive neuropsychology, and developmental psychology in both humans and nonhuman primates.


Assuntos
Evolução Biológica , Cognição , Emoções , Animais , Encéfalo/fisiologia , Cognição/fisiologia , Emoções/fisiologia , Humanos , Transtornos Mentais/fisiopatologia , Filogenia , Primatas
13.
J Alzheimers Dis ; 82(2): 827-839, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34092629

RESUMO

BACKGROUND: Adherence to the Mediterranean-DASH for Neurodegenerative Delay (MIND) diet has previously been associated with cognitive decline and dementia. To our knowledge, no prior study has investigated the association between the MIND diet and measures of brain volume, silent brain infarcts (SBIs), or brain atrophy. OBJECTIVE: We evaluated whether adherence to the MIND diet associated with superior cognitive function, larger brain volumes, fewer SBIs, and less cognitive decline in the community-based Framingham Heart Study. METHODS: 2,092 participants (mean±SD, age 61±9) completed Food Frequency Questionnaires, averaged across a maximum of 3-time points (examination cycles 5, 6, and 7), cognitive testing at examination cycle 7 (present study baseline: 1998-2001) and after a mean±SD of 6.6±1.1 years from baseline (n = 1,584). A subset of participants also completed brain magnetic resonance imaging (MRI) at examination cycle 7 (n = 1,904). In addition, participants with dementia, stroke, and other relevant neurological diseases such as significant head trauma, subdural hematoma, or multiple sclerosis were excluded from the analyses. RESULTS: Higher MIND diet scores were associated with better global cognitive function (ß±SE,+0.03SD±0.01; p = 0.004), verbal memory, visual memory, processing speed, verbal comprehension/reasoning, and with larger total brain volume (TBV) following adjustments for clinical, lifestyle and demographic covariates, but not with other brain MRI measures (i.e., hippocampal volume, lateral ventricular volume, white matter hyperintensity volume, and SBIs) or cognitive decline. CONCLUSION: Higher MIND diet scores associated with better cognitive performance and larger TBV at baseline, but not with cognitive decline. Clinical trials are needed to ascertain whether adopting the MIND diet affects trajectories of cognitive decline.


Assuntos
Encéfalo , Cognição/fisiologia , Disfunção Cognitiva , Dieta Mediterrânea , Cooperação do Paciente , Idoso , Doenças Assintomáticas , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Infarto Encefálico/diagnóstico , Infarto Encefálico/epidemiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/prevenção & controle , Dieta Mediterrânea/psicologia , Dieta Mediterrânea/estatística & dados numéricos , Feminino , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Tamanho do Órgão , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Resultado do Tratamento
14.
J Alzheimers Dis ; 82(2): 737-748, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34092630

RESUMO

BACKGROUND: Older adults with bipolar disorder (BD) have increased dementia risk, but signs of dementia are difficult to detect in the context of pre-existing deficits inherent to BD. OBJECTIVE: To identify the emergence of indicators of early dementia in BD. METHODS: One hundred and fifty-nine non-demented adults with BD from the National Alzheimer's Coordinating Center (NACC) data repository underwent annual neuropsychological assessment up to 14 years (54.0 months average follow-up). Cognitive performance was examined longitudinally with linear mixed-effects models, and yearly differences between incident dementia cases and controls were examined in the six years prior to diagnosis. RESULTS: Forty participants (25.2%) developed dementia over the follow-up period ('incident dementia cases'). Alzheimer's disease was the most common presumed etiology, though this was likely a result of sampling biases within NACC. Incident dementia cases showed declining trajectories in memory, language, and speeded attention two years prior to dementia onset. CONCLUSION: In a sample of BD patients enriched for Alzheimer's type dementia, prodromal dementia in BD can be detected up to two years before onset using the same cognitive tests used in psychiatrically-healthy older adults (i.e., measures of verbal recall and fluency). Cognition in the natural course of BD is generally stable, and impairment or marked decline on measures of verbal episodic memory or semantic retrieval may indicate an early neurodegenerative process.


Assuntos
Envelhecimento , Transtorno Bipolar , Cognição/fisiologia , Demência , Doenças Neurodegenerativas , Sintomas Prodrômicos , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Transtorno Bipolar/complicações , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/psicologia , Demência/diagnóstico , Demência/etiologia , Demência/fisiopatologia , Demência/psicologia , Feminino , Humanos , Masculino , Memória Episódica , Processos Mentais/fisiologia , Rememoração Mental/fisiologia , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/fisiopatologia , Doenças Neurodegenerativas/psicologia , Testes Neuropsicológicos , Estados Unidos/epidemiologia
15.
J Alzheimers Dis ; 82(2): 749-760, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34092631

RESUMO

BACKGROUND: Many studies have shown the impact of acute aerobic exercises (AAE) on cognition in healthy adults or at a pre-dementia stage. Few studies, however, have explored the positive effects of AAE in moderate Alzheimer's disease (ADM) patients. OBJECTIVE: Evaluating the effect of AAE on cognitive functions in ADM patients. METHODS: Overall, 79 (age: 69.62±0.99) ADM patients were recruited. Participants were divided into three groups according to the task: aerobic exercises done alone or combined with cognitive games presented on a screen, and a control group who performed a reading task. The aerobic exercise protocol consisted of a 20-min cycling exercise of moderate intensity, corresponding to 60%of the individual target maximal heart rate recorded in a 6-minute walking test. The participants' cognition was monitored before and after the intervention using the Tower of Hanoi, Digit Span, and Stroop tasks. RESULTS: After the exercise, the participants' attention in both the physical and combined groups improved for the Stroop, the forward and backward Digit Span tasks, as well as the time taken to solve the Tower of Hanoi, although no significant differences were found in the number of moves taken in the latter. By contrast, the control group did not show any significant improvement for most of the cognitive tasks after the reading session. CONCLUSION: Current evidence suggests that AAE may help to improve cognitive functions in ADM patients. This improvement is enhanced when the exercise is combined with cognitive games. Safe and progressive types of exercises should be promoted among ADM patients.


Assuntos
Doença de Alzheimer , Cognição/fisiologia , Exercício Físico/psicologia , Monitorização Fisiológica/métodos , Idoso , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/psicologia , Atenção/fisiologia , Feminino , Humanos , Masculino , Memória de Curto Prazo/fisiologia , Testes de Estado Mental e Demência , Testes Neuropsicológicos , Avaliação de Resultados em Cuidados de Saúde , Gravidade do Paciente , Sintomas Prodrômicos
16.
J Alzheimers Dis ; 82(2): 673-687, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34092633

RESUMO

BACKGROUND: Cognitive frailty (CF) is identified as one of the main precursors of dementia. Multidomain intervention has been found to delay or prevent the onset of CF. OBJECTIVE: The aim of our present study is to determine the effectiveness of a comprehensive, multidomain intervention on CF; to evaluate its cost effectiveness and the factors influencing adherence toward this intensive intervention. METHODS: A total of 1,000 community dwelling older adults, aged 60 years and above will be screened for CF. This randomized controlled trial involves recruitment of 330 older adults with CF from urban, semi-urban, and rural areas in Malaysia. Multidomain intervention comprised of physical, nutritional, cognitive, and psychosocial aspects will be provided to participants in the experimental group (n = 165). The control group (n = 165) will continue their usual care with their physician. Primary outcomes include CF status, physical function, psychosocial and nutritional status as well as cognitive performance. Vascular health and gut microbiome will be assessed using blood and stool samples. A 24-month intensive intervention will be prescribed to the participants and its sustainability will be assessed for the following 12 months. The effective intervention strategies will be integrated as a personalized telerehabilitation package for the reversal of CF for future use. RESULTS: The multidomain intervention developed from this trial is expected to be cost effective compared to usual care as well as able is to reverse CF. CONCLUSION: This project will be part of the World-Wide FINGERS (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) Network, of which common identifiable data will be shared and harmonized among the consortia.


Assuntos
Cognição/fisiologia , Disfunção Cognitiva , Dieta Saudável/métodos , Idoso Fragilizado/psicologia , Desempenho Físico Funcional , Serviços Preventivos de Saúde , Intervenção Psicossocial/métodos , Idoso , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/prevenção & controle , Disfunção Cognitiva/psicologia , Análise Custo-Benefício , Feminino , Humanos , Vida Independente , Masculino , Programas de Rastreamento/métodos , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/métodos , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Telerreabilitação/métodos
17.
J Alzheimers Dis ; 82(2): 701-717, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34092635

RESUMO

BACKGROUND: Physical exercise is suggested to be effective for preventing cognitive decline in older adults, but the relative efficacy of different types of exercise have yet to be clarified. OBJECTIVE: This single-blinded randomized controlled trial was designed to investigate the differential effects of aerobic exercise training (AT), resistance exercise training (RT), and combined exercise training (CT) on cognition in older adults with subjective memory complaints (SMC). METHODS: Community-dwelling older adults with SMC (n = 415; mean age = 72.3 years old) were randomly assigned to one of the four groups: AT, RT, CT, or control group. The study consisted of two phases: a 26-week intervention and a 26-week follow-up. The participants were evaluated at baseline, 26 weeks (postintervention), and 52 weeks (follow-up). The primary outcome of this study was memory function, which was assessed using the Logical Memory II subtest of the Wechsler Memory Scale-Revised (WMS-R) score. The secondary outcomes included global cognitive function, verbal fluency, working memory, processing speed, and executive functions. RESULTS: Intention-to-treat analysis by a mixed-effect model repeated measure showed that the AT group had significantly improved performance on the WMS-R Logical Memory II test (2.74 [1.82-3.66] points) than the control group (1.36 [0.44-2.28] points) at the postintervention assessment (p = 0.037). The effect was more pronounced in those without amnesia than those with amnesia. No significant improvement was observed in the RT and CT groups. CONCLUSION: This study suggests that AT intervention can improve delayed memory in community-dwelling older adults, particularly in individuals without objective memory decline.


Assuntos
Cognição/fisiologia , Autoavaliação Diagnóstica , Terapia por Exercício/psicologia , Exercício Físico/psicologia , Transtornos da Memória , Treinamento de Força/métodos , Idoso , Função Executiva/fisiologia , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Memória/fisiologia , Transtornos da Memória/diagnóstico , Transtornos da Memória/prevenção & controle , Transtornos da Memória/psicologia , Saúde Mental , Testes Neuropsicológicos , Avaliação de Resultados em Cuidados de Saúde
18.
J Alzheimers Dis ; 82(2): 719-726, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34092638

RESUMO

BACKGROUND: While both apolipoprotein E (APOE) genotype and diabetes affect longevity as well as Alzheimer's disease, their relationship remains to be elucidated. OBJECTIVE: The current study investigated the potential interaction between diabetes and APOE for lifespan and their relationship with cognitive status. METHODS: We reviewed the National Alzheimer's Coordinating Center (NACC) dataset, which documents longitudinally clinical records of 24,967 individuals with APOE genotype and diabetic status. RESULTS: Diabetes was associated with shorter lifespan in APOE3 carriers (n = 12,415, HR = 1.29, 95%CI = 1.17-1.42, p < 0.001) and APOE2 carriers (n = 2,390, HR = 1.37, 95%CI = 1.10-1.69, p = 0.016), while such associations were weaker and not significant in APOE4 carriers (n = 9,490, HR = 1.11, 95%CI = 0.99-1.24, p = 0.162). As there is a significant interactive effect of cognitive status and diabetes on lifespan (p < 0.001), we stratified subjects by cognitive status and observed persistent APOE-dependent harmful effects of diabetes in nondemented individuals but not demented individuals. Notably, questionnaire-based activity status, with which we previously observed an association between APOE genotype and longevity, was also significantly affected by diabetes only in non-APOE4 carriers. CONCLUSION: The effects of diabetes on longevity vary among APOE genotype. These effects are observed in nondemented individuals and are potentially associated with activity status during their lifespan.


Assuntos
Doença de Alzheimer , Apolipoproteína E2/genética , Apolipoproteína E3/genética , Apolipoproteína E4/genética , Cognição/fisiologia , Diabetes Mellitus , Exercício Físico , Longevidade/fisiologia , Idoso , Doença de Alzheimer/genética , Doença de Alzheimer/metabolismo , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/metabolismo , Exercício Físico/fisiologia , Exercício Físico/psicologia , Feminino , Genótipo , Humanos , Estudos Longitudinais , Masculino , Inquéritos e Questionários , Análise de Sobrevida , Estados Unidos/epidemiologia
19.
J Alzheimers Dis ; 82(2): 815-826, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34092639

RESUMO

BACKGROUND: Socioeconomic factors are important contributors to brain health. However, data from developing countries (where social inequalities are the most prominent) are still scarce, particularly about hypertensive individuals. OBJECTIVE: To evaluate the relationship between socioeconomic index, cognitive function, and cortical brain volume, as well as determine whether white matter hyperintensities are mediators of the association of the socioeconomic index with cognitive function in hypertensive individuals. METHODS: We assessed 92 hypertensive participants (mean age = 58±8.6 years, 65.2%female). Cognitive evaluation and neuroimaging were performed and clinical and sociodemographic data were collected using questionnaires. A socioeconomic index was created using education, income, occupation (manual or non-manual work), and race. The associations of the socioeconomic index with cognitive performance and brain volume were investigated using linear regression models adjusted for age, sex, time of hypertension since diagnosis, and comorbidities. A causal mediation analysis was also conducted. RESULTS: Better socioeconomic status was associated with better visuospatial ability, executive function, and global cognition. We found associations between a better socioeconomic index and a higher parietal lobe volume. White matter hyperintensities were also not mediators in the relationship between the socioeconomic index and cognitive performance. CONCLUSION: Socioeconomic disadvantages are associated with worse cognitive performance and brain volume in individuals with hypertension.


Assuntos
Encéfalo , Cognição/fisiologia , Função Executiva/fisiologia , Hipertensão , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Brasil/epidemiologia , Comorbidade , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/psicologia , Masculino , Análise de Mediação , Neuroimagem/métodos , Tamanho do Órgão , Medição de Risco , Fatores de Risco , Fatores Socioeconômicos
20.
Medicine (Baltimore) ; 100(24): e26275, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128859

RESUMO

ABSTRACT: This study was conducted to investigate the effects of the degree of dual-task (DT) interference on gait, dual-task cost (DTC), cognitive ability, balance, and fall efficacy in people with stroke.In this cross-sectional study, people with chronic stroke (N = 36) performed a DT gait assessment (gait and cognitive task). During the evaluation, DT interference in motor and cognition was evaluated simultaneously. Thus, the group with severe interference in both tasks (mutual interference) was compared with the group with mild interference in either.The main effects for the degree of motor interference were observed on gait performance, DTC in motor, time up and go, and trail-making test B. In the cognitive interference, the main effects were observed on correct response rate, DTC in cognition, time up and go, and trail-making test B. An interaction effect was observed in the trail-making test B.The degree of motor interference affected gait, balance ability, and executive function (EF), and the degree of cognitive interference influenced the correct response rate in the DT condition, balance ability, and EF. Furthermore, mutual interference led to a significant reduction in EF in people with stroke.


Assuntos
Cognição/fisiologia , Marcha/fisiologia , Equilíbrio Postural/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Acidentes por Quedas , Idoso , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Desempenho Psicomotor/fisiologia , Reabilitação do Acidente Vascular Cerebral , Análise e Desempenho de Tarefas
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