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1.
Medicine (Baltimore) ; 98(42): e17557, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626119

RESUMO

BACKGROUND: Mild cognitive impairment (MCI) and Alzheimer's disease (AD) are neurodegenerative diseases associated with aging. The major clinical features of both are progressive memory loss and progressive cognitive loss. The objective of this systematic review protocol is to provide the methods for evaluating the effectiveness of acupuncture in the treatment on cognitive deficits in transgenic mouse. METHODS AND ANALYSIS: We will search the electronic databases of PubMed, Web of Science, Embase, PsycINFO, as well as the Chinese databases such as Chinese Biomedicine Literature (CBM), Chinese Medical Current Content (CMCC), Chinese Scientific Journal Database (VIP), WanFang Database and China National Knowledge Infrastructure (CNKI) from their inceptions to July 2019. RevMan 5.3 software will be used for the data synthesis and the quality of each study was assessed independently by use of the CAMARADES checklist. RESULTS: This review will provide a high-quality synthesis based on present evidence of acupuncture treatment for AD and MCI in transgenic mouse models. CONCLUSIONS: This systematic review will provide evidence for weather acupuncture is an effective intervention for AD and MCI in transgenic mouse models. ETHICS AND DISSEMINATION: Ethical approval is not necessary since this protocol is only for systematic review and does not involve privacy data or conduct an animal experiment. This protocol will be disseminated by a peer-review journal or conference presentation. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019142985. STRENGTHS AND LIMITATIONS OF THIS STUDY: This systematic review will be the first to provide new knowledge underlying the effectiveness to improve cognitive function of acupuncture treatment for AD and MCI in transgenic mouse models. The result of this systematic review may provide experimental and theoretical basis for the future clinical application of acupuncture in the treatment of AD.The limitation of this systematic review may come from language barriers, because only English and Chinese can be included. Also, this study includes various kinds of acupuncture treatments which may result in essential heterogeneity.


Assuntos
Terapia por Acupuntura/métodos , Doença de Alzheimer/terapia , Cognição/fisiologia , Disfunção Cognitiva/terapia , Doença de Alzheimer/complicações , Doença de Alzheimer/fisiopatologia , Animais , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Modelos Animais de Doenças , Camundongos , Camundongos Transgênicos
2.
Medicine (Baltimore) ; 98(42): e17626, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626144

RESUMO

To establish a nomogram model to predict early cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients.A retrospective cohort study was held between January 2016 and October 2018. One hundred twenty seven out of 170 consecutive patients with supratentorial spontaneous intracranial hematoma were enrolled in this study. They were divided into development (n = 92) and validation (n = 35) dataset according to their admission time. Mini-mental State Examination (MMSE) was conducted between the third and the sixth month after the onset of stroke. MMSE ≤ 24 was considered as cognitive impairment. Univariate and multivariate logistic regression was used to screen for independent risk factors which correlate with cognitive impairment on the development dataset. A nomogram was built based on Akaike Information Criterion (AIC). Receiver operating characteristic (ROC) curve and calibration curve on development and validation dataset was drawn with each area under the curves (AUC) calculated. The decision curve analysis was also conducted with the development dataset.The bleeding volume, Glasgow Coma Scale (GCS), and intraventricular hemorrhage (IVH) are the most significant risk factors which may cause cognitive impairment both in the univariate and multivariate analysis. The finial model performed good discrimination ability on both development and validation dataset with AUC 0.911 and 0.919. Most patients would benefit from the model according to the decision curve analysis.A nomogram, constructed based on bleeding volume, GCS, and IVH can provide a feasible tool to evaluate cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients.


Assuntos
Hemorragia Cerebral/complicações , Cognição/fisiologia , Disfunção Cognitiva/diagnóstico , Hematoma/complicações , Nomogramas , Adulto , Hemorragia Cerebral/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Feminino , Seguimentos , Hematoma/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença
3.
Nat Neurosci ; 22(10): 1687-1695, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31551596

RESUMO

Working memory involves storing and/or manipulating previously encoded information over a short-term delay period, which is typically followed by a behavioral response based on the remembered information. Although working memory tasks often engage dorsolateral prefrontal cortex, few studies have investigated whether their subprocesses are localized to different cortical depths in this region, and none have done so in humans. Here we use high-resolution functional MRI to interrogate the layer specificity of neural activity during different periods of a delayed-response task in dorsolateral prefrontal cortex. We detect activity time courses that follow the hypothesized patterns: namely, superficial layers are preferentially active during the delay period, specifically in trials requiring manipulation (rather than mere maintenance) of information held in working memory, and deeper layers are preferentially active during the response. Results demonstrate that layer-specific functional MRI can be used in higher-order brain regions to noninvasively map cognitive processing in humans.


Assuntos
Memória de Curto Prazo/fisiologia , Córtex Pré-Frontal/fisiologia , Adulto , Mapeamento Encefálico/métodos , Cognição/fisiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Córtex Pré-Frontal/anatomia & histologia , Córtex Pré-Frontal/diagnóstico por imagem , Desempenho Psicomotor/fisiologia , Adulto Jovem
4.
Nat Neurosci ; 22(10): 1677-1686, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31551604

RESUMO

When experts are immersed in a task, do their brains prioritize task-related activity? Most efforts to understand neural activity during well-learned tasks focus on cognitive computations and task-related movements. We wondered whether task-performing animals explore a broader movement landscape and how this impacts neural activity. We characterized movements using video and other sensors and measured neural activity using widefield and two-photon imaging. Cortex-wide activity was dominated by movements, especially uninstructed movements not required for the task. Some uninstructed movements were aligned to trial events. Accounting for them revealed that neurons with similar trial-averaged activity often reflected utterly different combinations of cognitive and movement variables. Other movements occurred idiosyncratically, accounting for trial-by-trial fluctuations that are often considered 'noise'. This held true throughout task-learning and for extracellular Neuropixels recordings that included subcortical areas. Our observations argue that animals execute expert decisions while performing richly varied, uninstructed movements that profoundly shape neural activity.


Assuntos
Cognição/fisiologia , Movimento/fisiologia , Neurônios/fisiologia , Animais , Percepção Auditiva/fisiologia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/fisiologia , Tomada de Decisões/fisiologia , Modelos Lineares , Camundongos , Camundongos Endogâmicos C57BL , Neuroimagem , Desempenho Psicomotor/fisiologia , Percepção Visual/fisiologia
5.
Neuron ; 103(3): 380-394, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31394063

RESUMO

The Ca2+/calmodulin (CaM)-dependent protein kinase II (CaMKII) was touted as a memory molecule, even before its involvement in long-term potentiation (LTP) was shown. The enzyme has not disappointed, with subsequent demonstrations of remarkable structural and regulatory properties. Its neuronal functions now extend to long-term depression (LTD), and last year saw the first direct evidence for memory storage by CaMKII. Although CaMKII may have taken the spotlight, it is a member of a large family of diverse and interesting CaM kinases. Our aim is to place CaMKII in context of the other CaM kinases and then review certain aspects of this kinase that are of current interest.


Assuntos
Proteína Quinase Tipo 2 Dependente de Cálcio-Calmodulina/fisiologia , Sequência de Aminoácidos , Animais , Encéfalo/enzimologia , Proteína Quinase Tipo 2 Dependente de Cálcio-Calmodulina/química , Cognição/fisiologia , Humanos , Potenciação de Longa Duração/fisiologia , Memória/fisiologia , Modelos Moleculares , Família Multigênica , Proteínas do Tecido Nervoso/química , Proteínas do Tecido Nervoso/fisiologia , Fosforilação , Conformação Proteica , Domínios Proteicos , Mapeamento de Interação de Proteínas , Processamento de Proteína Pós-Traducional , Proteínas Serina-Treonina Quinases/classificação , Proteínas Serina-Treonina Quinases/fisiologia , Receptores de N-Metil-D-Aspartato/metabolismo , Transmissão Sináptica
6.
Chirurg ; 90(11): 930-935, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31468065

RESUMO

BACKGROUND: Gastrointestinal cancer is a frequent diagnosis in older patients. A curative resection, possibly in combination with radiotherapy and/or chemotherapy, is the standard therapy. The advanced age of the patients with an increasing number of comorbidities and often the presence of cognitive impairment represents a high risk for perioperative complications and a longer stay in hospital. The challenge in the clinical routine is to recognize a cognitive impairment in older patients and to prepare these patients for the operative intervention in the best possible way. OBJECTIVE: This retrospective analysis was carried out to find out whether preoperative cognitive impairment is a prognostic factor for the postoperative outcome. METHODS: In patients over the age of 75 years who were prepared for abdominal surgery of gastrointestinal cancer in the preoperative consultation, the mini mental state examination (MMSE) and the clock test were carried out. The results of the tests were retrospectively compared with the complication rate and the duration of hospital stay. RESULTS: Low MMSE values were significantly associated with the complication rate and the development of a severe complication (Clavien-Dindo grade ≥ 3a). A cut-off value of 24 points in the MMSE was predictive for the development of complications and a longer hospital stay. The age of the patients was not associated with the MMSE. CONCLUSION: Cognitive impairment is an important prognostic factor for the development of perioperative complications and the duration of the hospital stay in patients undergoing extensive abdominal surgery for gastrointestinal cancer. Therefore, a preoperative assessment, for example with the MMSE, is recommended in order to identify high-risk patients.


Assuntos
Transtornos Cognitivos/diagnóstico , Cognição , Hospitalização , Idoso , Idoso de 80 Anos ou mais , Cognição/fisiologia , Feminino , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos
7.
Zhonghua Nei Ke Za Zhi ; 58(9): 656-661, 2019 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-31461816

RESUMO

Objective: To explore the relationship between plasma amyloid-ß (Aß) and cognitive decline during 2 year follow-up in a population-based cohort in Xi'an rural areas. Methods: The study was conducted in Qubao village in Xi'an suburbs cognitively normal residents over 40 years old were recruited from October 2014 to March 2015 and given a face-to-face standardized interview. Mini-mental state examination (MMSE) was employed to evaluate the global cognitive function, and quantification of plasma Aß was measured by sandwich enzyme-linked immunosorbent assay (ELISA) at baseline. Two years later, MMSE was tested at the end of study. Then logistic regression was performed to analyze the relationship between baseline Aß and cognitive change during 2 year follow-up. Results: A total of 1 020 participants completed the study, among whom 223 subjects (21.9%) presented MMSE scores decline (defined as MMSE scores decreased ≥2 points). Compared with those without decline, participants in the MMSE decline group were older (P<0.001) and had lower education level (P<0.001), while gender, hypertension, hyperlipemia, diabetes mellitus and APOE genotype were not significantly different between two groups. One-way analysis of variance (ANOVA) showed that the MMSE score decline was slighter in the lower tertile of baseline Aß(1)-40 compared with middle tertile (P=0.012), while MMSE decline were similar between different Aß(1)-42 level groups and Aß(1-42)/Aß(1-40) ratio groups (P=0.758, P=0.671, respectively). Multivariable logistic regression analysis showed that MMSE scores in the lower baseline plasma Aß(1-40) level declined more slowly (OR=0.565, 95%CI 0.379-0.845, P=0.005). However, the MMSE decline were also similar among different baseline plasma Aß(1-42) levels groups and Aß(1-42)/Aß(1-40) ratio groups. Conclusion: Population with lower level of baseline plasma Aß(1-40) manifests lower cognitive decline during 2 years, however further investigation on dynamics of plasma Aß and long term follow up are needed.


Assuntos
Peptídeos beta-Amiloides/sangue , Cognição/fisiologia , Disfunção Cognitiva/diagnóstico , População Rural , Adulto , Idoso , Disfunção Cognitiva/sangue , Estudos de Coortes , Seguimentos , Humanos , Pessoa de Meia-Idade , Vigilância da População
8.
Psychol Aging ; 34(6): 766-779, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393145

RESUMO

Hearing impairment is associated with poorer cognitive function in later life. We tested for the potential contribution of childhood cognitive ability to this relationship. Childhood cognitive ability is strongly related to cognitive function in older age, and may be related to auditory function through its association with hearing impairment risk factors. Using data from the Lothian Birth Cohort, 1936, we tested whether childhood cognitive ability predicted later-life hearing ability then whether this association was mediated by demographic or health differences. We found that childhood cognitive ability was negatively associated with hearing impairment risk at age 76 (odds ratio = .834, p = .042). However, this association was nonsignificant after subsequent adjustment for potentially mediating demographic and health factors. Next, we tested whether associations observed in older age between hearing impairment and general cognitive ability level or change were accounted for by childhood cognitive ability. At age 76, in the minimally adjusted model, hearing impairment was associated with poorer general cognitive ability level (ß = -.119, p = .030) but was not related to decline in general cognitive ability. The former association became nonsignificant after additional adjustment for childhood cognitive ability (ß = -.068, p = .426) suggesting that childhood cognitive ability contributes (potentially via demographic and health differences) to the association between levels of hearing and cognitive function in older age. Further work is needed to test whether early life cognitive ability also contributes to the association (documented in previous studies) between older-age hearing impairment and cognitive decline. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Envelhecimento/fisiologia , Transtornos Cognitivos/etiologia , Cognição/fisiologia , Envelhecimento Cognitivo/psicologia , Disfunção Cognitiva/complicações , Disfunção Cognitiva/fisiopatologia , Perda Auditiva/complicações , Fatores Etários , Idoso , Envelhecimento/psicologia , Criança , Transtornos Cognitivos/diagnóstico , Feminino , Perda Auditiva/diagnóstico , Humanos , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Fatores de Risco
9.
West Afr J Med ; 36(2): 158-164, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385602

RESUMO

OBJECTIVE: Previous reports has shown that asthmatic patients with poor asthma control exhibited cognitive dysfunction. However, there is paucity of information on the cognitive functions of patients with clinically stable asthma particularly in sub-Saharan Africa. Subjects, study setting, materials and methods: This was a cross-sectional study conducted at the Federal Medical Centre, Owo, South West Nigeria from 2014-2016. Forty patients with mild to moderate asthma and forty matched (age, sex and educational status) non-asthmatic control subjects were included. Spirometry was done for all participants. Cognitive performance on domains of psychomotor speed, attention/concentration, memory and vigilance were assessed in all the participants using the Fepsy neuropsychological test battery Results: The mean age of the patients with asthma in years was 38.65±16.67 while that of the control subjects was 39.18±11.64 years. The patients with asthma had prolonged visual and binary choice reaction time relative to controls. Older asthmatic patients had prolonged visual and binary choice reaction time when compared to controls (p<0.05) while other socio-demographic clinical characteristics of the patients did not have impact on their cognitive performance (p>0.05). CONCLUSION: Cognitive performance was similar between the patients with mild to moderate asthma and non-asthmatic controls. Older asthmatic patients have impaired psychomotor speed relative to younger asthmatic patients.


Assuntos
Asma/diagnóstico , Transtornos Cognitivos/etiologia , Cognição/fisiologia , Desempenho Psicomotor/fisiologia , Adolescente , Adulto , Fatores Etários , Asma/complicações , Estudos de Casos e Controles , Transtornos Cognitivos/diagnóstico , Estudos Transversais , Humanos , Memória , Pessoa de Meia-Idade , Testes Neuropsicológicos , Nigéria
10.
Life Sci ; 233: 116698, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31356906

RESUMO

AIM: Type 1 diabetes (T1DM) is a common chronic disease in childhood. Increasing insulin resistance in puberty gives rise to higher doses of insulin usage in treatment. Of this reason new approaches in treatment are needed. Noopept researches suggest it to have anti-diabetic properties. We tried to determine the effects of noopept on pubertal diabetes. MAIN METHOD: The research was made with 60 prepubertal, 28 day-old, male, Sprague Dawley rats. The rats were divided into randomised 6 groups (n = 10/group). i) Control, ii) Diabetes Control, iii) Noopept Control, iv) Diabetes + Noopept, v) Diabetes + Insulin, vi) Diabetes + Insulin + Noopept. T1DM model was induced by streptozotocin on postnatal 28th day. 0.5 mg/kg noopept and 1 IU insulin were administered intraperitoneally for 14 days. Blood glucose and body weight measurements, puberty follow-up and MWM tests were performed. Hippocampus, hypothalamus and testis were evaluated histologically. Hypothalamic GnRH and kisspeptin were studied immunohistochemically. Serum LH, FSH and insulin, hippocampal homogenate NGF and BDNF levels were determined by ELISA. KEY FINDINGS: Delayed puberty was normalized by noopept (p < 0.05). Blood glucose levels were lower in noopept-administered diabetic groups (p < 0.05). Noopept decreased HOMA-IR in insulin administered diabetic group (p < 0.05). Number of degenerated cells in hippocampus and testis were higher in diabetes control group when compared with other groups (p < 0.05). GnRH immunoreactivity in Diabetes + Noopept group was increased when compared to insulin + noopept group (p = 0.018). There was no difference in kisspeptin, serum LH, FSH, hippocampal NGF-BDNF levels and spatial learning assessment among groups (p > 0.05). SIGNIFICANCE: Noopept may have positive effect in treatment of pubertal diabetes.


Assuntos
Cognição/fisiologia , Diabetes Mellitus Experimental/tratamento farmacológico , Dipeptídeos/farmacologia , Resistência à Insulina , Fármacos Neuroprotetores/farmacologia , Puberdade/fisiologia , Animais , Glicemia/metabolismo , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Cognição/efeitos dos fármacos , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/patologia , Insulina/metabolismo , Masculino , Fator de Crescimento Neural/metabolismo , Puberdade/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley
11.
BMC Neurol ; 19(1): 151, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277587

RESUMO

BACKGROUND: This study aimed to investigate the cerebral blood flow (CBF) and frontal lobe cognitive function in severe internal carotid artery (ICA) stenosis patients with different types of collateral circulation. METHODS: One hundred twenty-six patients with severe unilateral ICA stenosis were enrolled. Digital subtraction angiography (DSA) was performed to recruit patients with one of three common types of collateral circulation: anterior communicating artery (AcoA), posterior communicating artery (PcoA) and ophthalmic artery (OA). The hemodynamic parameters of the middle cerebral artery (MCA) were measured using transcranial Doppler (TCD), and the individual frontal lobe cognitive attention functions were evaluated using Word Fluency Test, Trail-Making Test (TMT), Digit Span, and Stroop Color Word Test (SCWT). The correlation between hemodynamic changes and the scores of all tasks was analyzed. RESULTS: On the side of arterial stenosis, the CBF velocities were highest in AcoA group and lowest in the OA group. All patients performed worse in TMT and Digit Span than the matched normal controls. The AcoA group exhibited a lower pulsatility index (PI) and a longer response time in the Stroop task, but had a higher accuracy rate in the Stroop task and higher scores in Word Fluency Test than the PcoA and OA groups. In all the three groups, PI was positively correlated with the accuracy rate for Stroop interference effects. CONCLUSIONS: Our findings suggested that the frontal lobe cognitive function of patients with ICA was impaired, and AcoA collaterals may be beneficial for selective attention functions, whereas OA collaterals may be associated with impairment of selective attention functions. Additionally, a high PI may be an indicator for identifying impaired selective attention in patients with severe ICA stenosis.


Assuntos
Estenose das Carótidas/fisiopatologia , Circulação Cerebrovascular , Cognição/fisiologia , Circulação Colateral , Lobo Frontal/fisiopatologia , Idoso , Angiografia Digital , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/psicologia , Estudos de Casos e Controles , Círculo Arterial do Cérebro , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média , Artéria Oftálmica , Ultrassonografia Doppler Transcraniana
12.
Nat Commun ; 10(1): 2949, 2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31270314

RESUMO

Recent analyses have shown educational attainment to be associated with a number of health outcomes. This association may, in part, be due to an effect of educational attainment on smoking behaviour. In this study, we apply a multivariable Mendelian randomisation design to determine whether the effect of educational attainment on smoking behaviour is due to educational attainment or general cognitive ability. We use individual data from the UK Biobank study (N = 120,050) and summary data from large GWA studies of educational attainment, cognitive ability and smoking behaviour. Our results show that more years of education are associated with a reduced likelihood of smoking that is not due to an effect of general cognitive ability on smoking behaviour. Given the considerable physical harms associated with smoking, the effect of educational attainment on smoking is likely to contribute to the health inequalities associated with differences in educational attainment.


Assuntos
Cognição/fisiologia , Escolaridade , Análise da Randomização Mendeliana , Fumar/genética , Viés , Estudo de Associação Genômica Ampla , Humanos , Razão de Chances
13.
Psychol Aging ; 34(5): 714-728, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31259564

RESUMO

We examined the role of personality and health as time-invariant and time-varying predictors of changes in different cognitive domains based on data from the Interdisciplinary Longitudinal Study on Adult Development. Our sample consisted of 500 individuals born between 1930 and 1932 (baseline age: M = 62.87 years, SD = 0.89 years) who were assessed up to 4 times over an interval of up to 20 years. Cognitive abilities were measured by multiple well-established tests representing crystallized intelligence, fluid intelligence, and information processing speed. Because of poor psychometric properties of openness in our sample, only 4 of the Big Five personality traits (neuroticism, extraversion, agreeableness, and conscientiousness) were used. Based on in-depth medical examinations, physicians rated study participants' health. When considered as time-invariant predictors, lower baseline neuroticism and extraversion scores were associated with better baseline performance on the crystallized and fluid ability tests. Higher initial extraversion was associated with less steep decline in information processing speed. Worse baseline physician health was associated with lower baseline scores on fluid abilities and information processing speed. Moreover, worse initial health was associated with steeper decline in crystallized and fluid abilities. From a time-varying perspective, crystallized abilities were lower on measurement occasions when individuals revealed poorer health. Our findings suggest that late-life cognitive abilities are differentially related with personality and health. Overall, personality characteristics are associated with late-life cognitive abilities, but less so from a time-varying perspective. They also seem to be of limited importance for the prediction of long-term change in cognitive abilities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Envelhecimento/psicologia , Cognição/fisiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
14.
NeuroRehabilitation ; 44(4): 493-510, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256084

RESUMO

BACKGROUND: Dual-task (simultaneous motor and cognitive task) (DT) training via virtual-reality exergaming is known to benefit balance control post-stroke. However, the efficacy of such training on DT balance control (volitional and reactive) and cognitive (executive function and attention) domains associated with fall risk remains unclear. OBJECTIVE: We evaluated the efficacy of cognitive-motor exergame training (CMT) (Wii-fit games in conjunction with cognitive tasks) for improving balance control (volitional and reactive) and cognition (executive function and attention) among people with chronic stroke (PwCS). METHODS: Hemiparetic, ambulatory PwCS were randomly assigned to either CMT (n = 12) or conventional training (CT) (n = 12) and underwent six weeks of high-intensity, tapered balance training. The CMT group performed Wii-fit games in conjunction with cognitive tasks, while CT group underwent customized, progressive balance training. Performance under DT conditions on Limits of Stability (volitional) and Slip-Perturbation (reactive) tests, and letter-number sequencing (cognition) determined the efficacy of CMT. RESULTS: Post-intervention, under DT reactive conditions, CMT group improved both motor and cognition, while the CT group improved motor alone. Under DT volitional conditions, motor performance improved only in CMT group. CONCLUSION: Cognitive-motor exergaming appears to be effective for improving balance control and cognition and could be implemented in clinical stroke rehabilitation settings.


Assuntos
Acidentes por Quedas/prevenção & controle , Cognição/fisiologia , Terapia por Exercício/métodos , Atividade Motora/fisiologia , Acidente Vascular Cerebral/terapia , Jogos de Vídeo , Idoso , Atenção/fisiologia , Doença Crônica , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural/fisiologia , Fatores de Risco , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral/métodos , Jogos de Vídeo/psicologia
15.
NeuroRehabilitation ; 44(4): 555-567, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256092

RESUMO

BACKGROUND: There is no successful pharmacological treatment for cognitive impairment in Parkinson's Disease, therefore treatments capable of slowing down the progression of cognitive dysfunction are needed. OBJECTIVE: To evaluate the effectiveness of a cognitive training, supported by the CoRe computerized tool, in patients with Parkinson's Disease Mild Cognitive Impairment. METHODS: This is a prospective, open-unblinded, randomized, controlled study. After baseline cognitive assessment (T0), enrolled patients were randomized to receive motor rehabilitation plus cognitive intervention (G1) or motor rehabilitation only (G2). Follow-up assessments were scheduled 4 weeks (T1) and 6 months after (T2). Global cognitive functioning scores (MOCA and MMSE) were considered as primary outcome. Outcome measures at T0, T1 and T2 were compared within- and between-groups. A percentage change score between T0 and next assessments was calculated to identify patients who improved, remain stable or worsened. RESULTS: Differently from G2, G1 showed a medium/large effect size improvement in primary (MoCA) and secondary outcome, both between T0 and T1 and T0 and T2. Moreover, within G1, most patients improved their cognitive state compared to the baseline. CONCLUSIONS: Patients trained with CoRe showed a better evolution of cognitive decline, while untreated patients tended to get worse over time.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Disfunção Cognitiva/psicologia , Disfunção Cognitiva/terapia , Doença de Parkinson/psicologia , Doença de Parkinson/terapia , Terapia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Cognição/fisiologia , Disfunção Cognitiva/epidemiologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/epidemiologia , Estudos Prospectivos
16.
NeuroRehabilitation ; 44(4): 545-554, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282434

RESUMO

BACKGROUND: Neurosensory stimulation is effective in enhancing the recovery process of severely brain-injured patients with disorders of consciousness. Multisensory environments are found in nature, recognized as beneficial to many medical conditions. Recent advances detected covert cognition in patients behaviorally categorized as un- or minimally responsive; a state described as cognitive motor dissociation (CMD). OBJECTIVE: To determine effectiveness of a neurosensory stimulation approach enhanced by outdoor therapy, in the early phases of recovery in patients presenting with CMD. METHODS: A prospective non-randomized crossover study was performed. A two-phase neurosensory procedure combined identical individually goal assessed indoor and outdoor protocols. All sessions were video-recorded and observations rated offline. The frequency of volitional behavior was measured using a behavioral grid. RESULTS: Fifteen patients participated in this study. The outdoor group patients had statistically significant higher number of intentional behaviors than the indoor group on seven features of the grid. Additionally, for all items assessed, total amount of behaviors in the outdoor condition where higher than those in the indoor condition. CONCLUSIONS: Although preliminary, this study provides robust evidence supporting the effectiveness and appropriateness of an outdoor neurosensory intervention in patients with covert cognition, to improve adaptive goal-oriented behavior. This may be a step towards helping to restore functional interactive communication.


Assuntos
Lesões Encefálicas/terapia , Transtornos Cognitivos/terapia , Cognição/fisiologia , Recuperação de Função Fisiológica/fisiologia , Terapia Recreacional/métodos , Sensação/fisiologia , Adulto , Idoso , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/psicologia , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Estado de Consciência/fisiologia , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Ocupacional/métodos , Terapia Ocupacional/psicologia , Modalidades de Fisioterapia/psicologia , Estudos Prospectivos , Terapia Recreacional/psicologia , Adulto Jovem
17.
Orthop Nurs ; 38(4): 244-250, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343628

RESUMO

Cognitive impairment is a recognized predictor of acute delirium, particularly in the postoperative period. Estimates of up to 24% of patients experiencing delirium and its associated cognitive impairment during any orthopaedic procedure have been reported, with higher rates for those patients undergoing hip fracture repair. Primary prevention is the most effective strategy to maintain cognition and prevent delirium. The purpose of this article is to provide evidence-based recommendations to prevent acute delirium using bundles of care. Bundles of care are a set of 3-5 independent, evidence-based interventions that, when implemented together, result in significantly better outcomes than when implemented individually. The bundle consists of ongoing assessment of cognition, continuing orientation, and early mobilization and socialization.


Assuntos
Cognição/fisiologia , Delírio/prevenção & controle , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Humanos , Programas de Rastreamento/métodos , Procedimentos Ortopédicos/métodos , Prevenção Primária/métodos , Fatores de Risco
18.
Am J Occup Ther ; 73(4): 7304345020p1-7304345020p9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31318679

RESUMO

IMPORTANCE: Rehabilitation interventions for chronic stroke are largely impairment based, with results confined to the level of impairment instead of function. In contrast, cognitive strategy training interventions have demonstrated clinically meaningful improvements in functional outcomes. Integration of these approaches has yet to be explored. OBJECTIVE: To evaluate acceptability, recruitment, and retention rate and determine which outcome measures best capture the effect of the intervention. DESIGN: Single-group, pre-post design. SETTING: Research laboratory. PARTICIPANTS: Adults with chronic stroke and hemiparesis (N = 10). INTERVENTION: A 12-wk intervention integrating cognitive strategy training with upper extremity motor training. Two weekly sessions used Kinect-based virtual reality to encourage high numbers of upper extremity movement repetitions. The third weekly session focused on the use of cognitive strategies with practice of client-centered goals. OUTCOMES AND MEASURES: Upper extremity motor performance was measured with the Fugl-Meyer Assessment. Occupational performance on trained and untrained goals was measured via the Performance Quality Rating Scale and the Canadian Occupational Performance Measure. Outcome data were gathered preintervention, postintervention, and at 3-mo follow-up. RESULTS: The intervention was perceived as acceptable. Recruitment rate was 15%, and retention rate was 100%. Large effects were found on outcomes of upper extremity motor performance, occupational performance, and participation at follow-up. CONCLUSION AND RELEVANCE: MetacogVR is feasible for adults with chronic stroke. The effect of MetacogVR is best captured through measures of upper extremity motor performance, occupational performance, and participation. WHAT THIS ARTICLES ADDS: Traditional, impairment-based approaches to chronic stroke rehabilitation may require integration with cognitive-strategy training to affect performance on meaningful goals.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Realidade Virtual , Adulto , Cognição/fisiologia , Humanos , Recuperação de Função Fisiológica , Extremidade Superior/fisiologia
19.
Medicine (Baltimore) ; 98(27): e16315, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277175

RESUMO

Driving is an essential activity for community engagement in patients with brain injury. However, brain injury patients have cognitive-perceptual deficits and low independence in daily activities. The aims of this study were to identify the driving errors of brain injury patients and determine their relevance to cognitive-perception function and daily activity level. This study was conducted at a single rehabilitation hospital. Thirty-one brain injury patients were included in the study. The patients underwent a driving-scene-based simulator evaluation in the rehabilitation clinic. Driving errors were checked using automatic software. Perceptual ability was measured using Motor-free Visual Perceptual Test (MVPT) and Cognitive-perceptual Assessment for Driving (CPAD). A linear relationship was found between the driving aptitude score, steering wheel and judgment, simultaneous operation items, total score of road course test, and cognitive-perceptual functions and daily activity levels of the participants (P <.05). The general factors that affected driving errors included driving experience, age, part of the hemispheric affected, and presence of vascular injury (P <.05). In addition, the Korean version of Mini-Mental State Examination (K-MMSE) score and the CPAD score correlated with driving errors (P <.05). The total error score of the participants correlated with the Korean version of the Modified Barthel Index (K-MBI) score (P <.05).These findings suggest that driving experience and age have more influence on driving error than perceptual level due to brain damage. In addition, it was found that the basic level of daily living influences overall operating errors.


Assuntos
Atividades Cotidianas , Condução de Veículo/psicologia , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/psicologia , Cognição/fisiologia , Percepção/fisiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia
20.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(5): 614-618, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31198150

RESUMO

OBJECTIVE: To investigate the occurrence and influencing factors of long-term cognitive impairment in patients with sepsis. METHODS: The septic patients admitted to intensive care unit (ICU) of Tianjin Third Central Hospital from July 2014 to September 2017 were enrolled. Montreal cognitive assessment scale (MoCA) was used to assess the cognitive function of patients at 3, 12 and 24 months after discharge from hospital. The patients were divided into cognitive impairment group (MoCA score < 26) and normal cognitive function group (MoCA score ≥ 26) according to the MoCA scores at 12 months after discharge from hospital. The basic characteristics and clinical data were recorded in both groups, the variables with statistical significance in univariate analysis were enrolled in bivariate Logistic regression analysis, and the influencing factors of cognitive impairment in patients with sepsis were screened. RESULTS: During the study period, 1 748 patients with sepsis were admitted, 210 survived and discharged, and 125 patients participated in the follow-up. Cognitive impairment occurred in 61.6% (77/125), 54.4% (56/103) and 54.2% (39/72) of the septic patients at 3, 12 and 24 months after discharge, respectively. The MoCA score of 103 patients who completed 12-month follow-up was significantly higher than that of 3-month follow-up (23.4±5.7 vs. 23.0±6.0, P < 0.01); the MoCA score of 72 patients who completed 24-month follow-up was only slightly lower than that of 12-month follow-up (23.6±5.4 vs. 23.7±5.0, P > 0.05). Following up for 12 months, 47 patients were enrolled in the normal cognitive function group and 56 in the cognitive impairment group. Compared with the normal cognitive function group, the cognitive dysfunction group had more female [51.8% (29/56) vs. 31.9% (15/47)] and older patients (years old: 66.1±15.9 vs. 52.4±18.9), also had shorter time to receive education (years: 7.6±4.0 vs. 11.2±3.1), longer duration of delirium [days: 2 (0, 3) vs. 0 (0, 1)], with significant differences (all P < 0.05). There was no significant difference in the marital status, severity of infection, underlying diseases, routes of transfer, total length of hospital stay, the length of ICU stay, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, Charlson comorbidity index (CCI) score within 24 hours of admission to ICU, hypoxemia, hypotension, mechanical ventilation, hemofiltration, or drug use between the two groups. Bivariate Logistic regression analysis showed that the duration of education was a protective factor for cognitive impairment in patients with sepsis who were followed up for 12 months [odds ratio (OR) = 0.791, 95% confidence interval (95%CI) = 0.678-0.923, P = 0.003], and age and duration of delirium were risk factors (age: OR = 1.038, 95%CI = 1.009-1.068, P = 0.010; duration of delirium: OR = 1.314, 95%CI = 1.002-1.724, P = 0.048). CONCLUSIONS: Long-term cognitive impairment occurs in many septic patients after discharge and improves over time. Duration of education is a protective factor for cognitive impairment in patients with sepsis, while age and delirium duration are risk factors.


Assuntos
Cognição/fisiologia , Disfunção Cognitiva/epidemiologia , Sepse/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sepse/terapia
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