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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 256-259, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33017977

RESUMO

In recent years, electroencephalography (EEG) has emerged as a low-cost, accessible and objective tools for the early diagnosis of Alzheimer's disease (AD). AD is preceded by Mild Cognitive Impairment (MCI), typically refers to early-stage AD disease. The purpose of this study is to classify MCI patients from the multi-domain features of their electroencephalography (EEG). Firstly, we extracted the multi-domain (time, frequency and information theory) features from resting-state EEG signals before and after a cognitive task from 15 MCI groups and 15 age-matched healthy controls. Then, principal component analysis (PCA) was used to perform feature selection. After that, we compared the performance between SVM and KNN on our EEG dataset. The good performance was observed both from SVM and KNN, which demonstrates the effectiveness of multi-domain features. Furthermore, KNN performs better than SVM and the EEG signals after the cognitive task works better than those before the task.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Doença de Alzheimer/diagnóstico , Disfunção Cognitiva/diagnóstico , Eletroencefalografia , Humanos
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1762-1765, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018339

RESUMO

Subjective cognitive decline (SCD) is a high-risk preclinical stage in the progress of Alzheimer's disease (AD). Its timely diagnosis is of great significance for older adults. Though multi-parameter magnetic resonance imaging (MPMRI) is a noninvasive neuroimaging technique to detect SCD, the lack of biomarkers and computed aided diagnosis (CAD) tools is a major concern for its application. Radiomics, a high-dimensional imaging feature extraction method, has been widely used for identifying biomarkers and developing CAD tools in oncological studies. Therefore, in this study, we aimed to investigate whether the radiomic approach could be used for the diagnosis of SCD. In the proposed radiomic approach, we mainly performed four steps: image preprocessing, feature extraction and screening, and classification. The dataset from Xuanwu Hospital, Beijing, China, was used in this study, including 105 healthy controls (HC) and 130 SCD subjects. All subjects were divided into one training & validation group and one test group. We extracted 30128 radiomic features from MPMRI of each subject. The t-test, autocorrelation, and Fisher score were performed for feature selection, and we deployed the support vector machine (SVM) for classification. The above process was performed 100 times with 5-fold cross-validation. The results showed that the accuracy, sensitivity, and specificity of classification was 89.03%±5.37%, 85.44%±9.28% and 91.97%±6.38% in the validation set and 84.70%±4.68%, 86.98%±10.49% and 82.59%±7.07% in the test set. In conclusion, this study has shown that the radiomic approach could be used to discriminate SCD and HC with high accuracy and sensitivity effectively.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Idoso , Doença de Alzheimer/diagnóstico , China , Disfunção Cognitiva/diagnóstico , Humanos , Imagem por Ressonância Magnética , Máquina de Vetores de Suporte
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3204-3207, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018686

RESUMO

Alzheimer's disease (AD) affects approximately 30 million people worldwide, and this number is predicted to triple by 2050 unless further discoveries facilitate the early detection and prevention of the disease. Computerized walkways for simultaneous assessment of motor-cognitive performance, known as a dual-task assessment, has been used to associate changes in gait characteristics to mild cognitive impairment (MCI) with early-stage disease. However, to our best knowledge, there is no validated method to detect MCI using the collective analysis of these gait characteristics. In this paper, we develop a machine learning approach to analyze the gait data from the dual-task assessment in order to detect subjects with cognitive impairment from healthy individuals. We collected dual-task gait data from a computerized walkway of a total of 92 subjects with 31 healthy control (HC) and 61 MCI. Using support vector machine (SVM) and gradient tree boosting, we developed a classifier to differentiate MCI from HC subjects and compared the results with a paper-based questionnaire assessment that has been commonly used in clinical practice. SVM provided the highest accuracy of 77.17% with 81.97% sensitivity and 67.74% specificity. Our results indicate the potential of machine learning + dual-task assessment to enable early diagnosis of cognitive decline before it advances to dementia and AD, so that early intervention or prevention strategies can be initiated.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Doença de Alzheimer/diagnóstico , Disfunção Cognitiva/diagnóstico , Diagnóstico Precoce , Marcha , Humanos , Aprendizado de Máquina
4.
BMJ Case Rep ; 13(10)2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33060143

RESUMO

Early case series suggest that about one-third of patients with COVID-19 present with neurological manifestations, including cerebrovascular disease, reported in 2%-6% of hospitalised patients. These are generally older patients with severe infection and comorbidities. Here we discuss the case of a previously fit and well 39-year-old man who presented with fever and respiratory symptoms, evolving in pneumonia with hypoxia but only requiring continuous positive airway pressure. After resolution of the respiratory disease, the patient developed focal neurology and was found to have bilateral occipital, thalamic and cerebellar infarcts. A diagnosis of COVID-19 central nervous system vasculopathy was made. He developed a florid neuropsychiatric syndrome, including paranoia, irritability, aggression and disinhibition, requiring treatment with antipsychotics and transfer to neurorehabilitation. Neuropsychometry revealed a wide range of cognitive deficits. The rapid evolution of the illness was matched by fast resolution of the neuropsychiatric picture with mild residual cognitive impairment.


Assuntos
Sintomas Comportamentais , Infarto Encefálico , Tronco Encefálico , Doenças Cerebelares , Cerebelo , Disfunção Cognitiva , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Adulto , Sintomas Comportamentais/diagnóstico , Sintomas Comportamentais/fisiopatologia , Sintomas Comportamentais/reabilitação , Betacoronavirus/isolamento & purificação , Infarto Encefálico/diagnóstico , Infarto Encefálico/fisiopatologia , Infarto Encefálico/psicologia , Infarto Encefálico/reabilitação , Tronco Encefálico/irrigação sanguínea , Tronco Encefálico/diagnóstico por imagem , Doenças Cerebelares/fisiopatologia , Doenças Cerebelares/psicologia , Doenças Cerebelares/reabilitação , Doenças Cerebelares/virologia , Cerebelo/irrigação sanguínea , Cerebelo/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/reabilitação , Disfunção Cognitiva/virologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Humanos , Masculino , Exame Neurológico/métodos , Testes Neuropsicológicos , Pneumonia Viral/fisiopatologia , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Reabilitação Psiquiátrica/métodos , Resultado do Tratamento
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5498-5501, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019224

RESUMO

Early detection of dementia is crucial to devise effective interventions. Comprehensive cognitive tests, while being the most accurate means of diagnosis, are long and tedious, thus limiting their applicability to a large population, especially when periodic assessments are needed. The problem is compounded by the fact that people have differing patterns of cognitive impairment as they progress to different forms of dementia. This paper presents a novel scheme by which individual-specific patterns of impairment can be identified and used to devise personalized tests for periodic follow-up. Patterns of cognitive impairment are initially learned from a population cluster of combined normals and cognitively impaired subjects, using a set of standardized cognitive tests. Impairment patterns in the population are identified using a 2-step procedure involving an ensemble wrapper feature selection followed by cluster identification and analysis. These patterns have been shown to correspond to clinically accepted variants of Mild Cognitive Impairment (MCI), a prodrome of dementia. The learned clusters of patterns can subsequently be used to identify the most likely route of cognitive impairment, even for pre-symptomatic and apparently normal people. Baseline data of 24,000 subjects from the NACC database was used for the study.


Assuntos
Disfunção Cognitiva , Demência , Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Humanos , Aprendizagem
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5537-5543, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019233

RESUMO

The presented paper discusses a practical application of machine learning (ML) in the so-called 'AI for social good' domain and in particular concerning the problem of a potential elderly adult dementia onset prediction. An increase in dementia cases is producing a significant medical and economic weight in many countries. Approximately 47 million older adults live with a dementia spectrum of neurocognitive disorders, according to an up-to-date statement of the World Health Organization (WHO), and this amount will triple within the next thirty years. This growing problem calls for possible application of AI-based technologies to support early diagnostics for cognitive interventions and a subsequent mental wellbeing monitoring as well as maintenance with so-called 'digital-pharma' or 'beyond a pill' therapeutical strategies. The paper explains our attempt and encouraging preliminary study results of behavioral responses analysis in a facial emotion implicit-short-term-memory learning and evaluation experiment. We present results of various shallow and deep learning machine learning models for digital biomarkers of dementia progress detection and monitoring. The discussed machine-learning models result in median accuracies right below a 90% benchmark using classical shallow and deep learning approaches for automatic discrimination of normal cognition versus a mild cognitive impairment (MCI). The classifier input features consist of an older adult emotional valence and arousal recognition responses, together with reaction times, as well as with self-reported university-level degree education and age, as obtained from a group of 35 older adults participating voluntarily in the reported dementia biomarker development project. The presented results showcase the inherent social benefits of artificial intelligence (AI) utilization for the elderly and establish a step forward to advance machine learning (ML) approaches for the subsequent employment of simple behavioral examination for MCI and dementia onset diagnostics.Clinical relevance- This manuscript establishes a behavioral and cognitive biomarker candidate potentially substituting a Montreal Cognitive Assessment (MoCA) evaluation without a paper and pencil test.


Assuntos
Disfunção Cognitiva , Demência , Idoso , Nível de Alerta , Inteligência Artificial , Biomarcadores , Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Emoções , Humanos
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5548-5552, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019235

RESUMO

Speech analysis could provide an indicator of cognitive health and help develop clinical tools for automatically detecting and monitoring cognitive health progression. The Mini Mental Status Examination (MMSE) is the most widely used screening tool for cognitive health. But the manual operation of MMSE restricts its screening within primary care facilities. An automatic screening tool has the potential to remedy this situation. This study aims to assess the association between acoustic features of spontaneous speech and assess whether acoustic features can be used to automatically predict MMSE score. We assessed the effectiveness of paralinguistic feature set for MMSE score prediction on a balanced sample of DementiaBank's Pitt spontaneous speech dataset, with patients matched by gender and age. Linear regression analysis shows that fusion of acoustic features, age, sex and years of education provides better results (mean absolute error, MAE = 4.97, and R2 = 0.261) than acoustic features alone (MAE = 5.66 and R2 =0.125) and age, gender and education level alone (MAE of 5.36 and R2 =0.17). This suggests that the acoustic features of spontaneous speech are an important part of an automatic screening tool for cognitive impairment detection.Clinical relevance- We hereby present a method for automatic screening of cognitive health. It is based on acoustic information of speech, a ubiquitous source of data, therefore being cost-efficient, non-invasive and with little infrastructure required.


Assuntos
Disfunção Cognitiva , Fala , Acústica , Disfunção Cognitiva/diagnóstico , Humanos , Testes de Estado Mental e Demência , Testes Neuropsicológicos
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5657-5660, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019260

RESUMO

The Clock Drawing Test, where the participant is asked to draw a clock from memory and copy a model clock, is widely used for screening of cognitive impairment. The digital version of the clock test, the digital clock drawing test (dCDT), employs accelerometer and pressure sensors of a digital pen to capture time and pressure information from a participant's performance in a granular digital format. While visual features of the clock drawing test have previously been studied, little is known about the relationship between demographic and cognitive impairment characteristics with dCDT latency and graphomotor features. Here, we examine dCDT feature clusters with respect to sociodemographic and cognitive impairment outcomes. Our results show that the clusters are not significantly different in terms of age and gender, but did significantly differ in terms of education, Mini-Mental State Exam scores, and cognitive impairment diagnoses.This study shows that features extracted from digital clock drawings can provide important information regarding cognitive reserve and cognitive impairments.


Assuntos
Disfunção Cognitiva , Reserva Cognitiva , Disfunção Cognitiva/diagnóstico , Humanos , Programas de Rastreamento , Memória , Testes Neuropsicológicos
9.
J Psychiatr Res ; 129: 98-102, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912598

RESUMO

This study aims to evaluate the impacts of COVID-19 on cognitive functions in recovered patients and its relationship with inflammatory profiles. Twenty-nine patients recovered from COVID-19 as confirmed by negative nucleic tests for two consecutive times were recruited. A total of 29 age-, gender- and education-matched healthy controls were also recruited. The cognitive functions of all subjects were evaluated by the iPad-based online neuropsychological tests, including the Trail Making Test (TMT), Sign Coding Test (SCT), Continuous Performance Test (CPT), and Digital Span Test (DST). Blood samples from all patients were collected for examining inflammatory profiles, including interleukin-2 (IL-2), IL-4, IL-6, IL-10, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and C-reactive protein (CRP). The relationship between cognitive functions and inflammatory profiles were analyzed by Pearson correlation. In results, although no significant differences were found in TMT, SCT, and DST between the two groups, patients with COVID-19 scored lower in the correct number of the second and third parts of CPT, they also scored higher in the missing number of the third part of CPT (all P < 0.05). In patients with COVID-19, there was a trend of significant difference for lower reaction time in the first and second parts of CPT (P = 0.050, and 0.051, respectively), as well as the lower correct number of the second part of CPT (P = 0.050). Correlation analysis showed that the reaction time for the first and second parts of CPT was positively correlated with the CRP levels (r = 0.557 and 0.410, P < 0.05). In conclusion, our findings indicated that cognitive impairments exist even in patients recovered from COVID-19, and might be possibly linked to the underlying inflammatory processes.


Assuntos
Betacoronavirus , Disfunção Cognitiva/complicações , Infecções por Coronavirus/complicações , Inflamação/complicações , Pneumonia Viral/complicações , Sobreviventes/estatística & dados numéricos , Adulto , Disfunção Cognitiva/diagnóstico , Infecções por Coronavirus/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos , Pandemias , Pneumonia Viral/psicologia
11.
Georgian Med News ; (304-305): 80-84, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32965254

RESUMO

The number of elderly and senile people with severe senile asthenia syndrome and cognitive disorders, which eventually develop into dementia, is increasing every year in the world. It is this disease that is the highest priority in the health care of the entire world community.; The article provides a historical overview of the creation of memory clinics that operate in the paradigm of providing community-based psychiatric care. The results of changes in the clinical-dynamic and epidemiological indicators of the prevalence of dementia in the direction of early detection of pre-dementia conditions with mild cognitive decline syndrome are presented. Global trends in the development of memory clinics for outpatient patients are considered.; The purpose of the study: to provide a comprehensive analysis of the available literature data on the feasibility of a multi-faceted approach in the development of the concept of memory clinics.


Assuntos
Transtornos Cognitivos , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Idoso , Envelhecimento , Assistência à Saúde , Humanos , Memória
12.
PLoS One ; 15(9): e0236868, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32976486

RESUMO

Detection and diagnosis of early and subclinical stages of Alzheimer's Disease (AD) play an essential role in the implementation of intervention and prevention strategies. Neuroimaging techniques predominantly provide insight into anatomic structure changes associated with AD. Deep learning methods have been extensively applied towards creating and evaluating models capable of differentiating between cognitively unimpaired, patients with Mild Cognitive Impairment (MCI) and AD dementia. Several published approaches apply information fusion techniques, providing ways of combining several input sources in the medical domain, which contributes to knowledge of broader and enriched quality. The aim of this paper is to fuse sociodemographic data such as age, marital status, education and gender, and genetic data (presence of an apolipoprotein E (APOE)-ε4 allele) with Magnetic Resonance Imaging (MRI) scans. This enables enriched multi-modal features, that adequately represent the MRI scan visually and is adopted for creating and modeling classification systems capable of detecting amnestic MCI (aMCI). To fully utilize the potential of deep convolutional neural networks, two extra color layers denoting contrast intensified and blurred image adaptations are virtually augmented to each MRI scan, completing the Red-Green-Blue (RGB) color channels. Deep convolutional activation features (DeCAF) are extracted from the average pooling layer of the deep learning system Inception_v3. These features from the fused MRI scans are used as visual representation for the Long Short-Term Memory (LSTM) based Recurrent Neural Network (RNN) classification model. The proposed approach is evaluated on a sub-study containing 120 participants (aMCI = 61 and cognitively unimpaired = 59) of the Heinz Nixdorf Recall (HNR) Study with a baseline model accuracy of 76%. Further evaluation was conducted on the ADNI Phase 1 dataset with 624 participants (aMCI = 397 and cognitively unimpaired = 227) with a baseline model accuracy of 66.27%. Experimental results show that the proposed approach achieves 90% accuracy and 0.90 F1-Score at classification of aMCI vs. cognitively unimpaired participants on the HNR Study dataset, and 77% accuracy and 0.83 F1-Score on the ADNI dataset.


Assuntos
Apolipoproteínas E/genética , Disfunção Cognitiva/diagnóstico , Imagem por Ressonância Magnética , Neuroimagem , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/patologia , Conjuntos de Dados como Assunto , Aprendizado Profundo , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
13.
J Stroke Cerebrovasc Dis ; 29(10): 105083, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912555

RESUMO

BACKGROUND AND PURPOSE: Older patients with pre-existing mild cognitive impairment (MCI) receive less evidence-based care after acute myocardial infarction, however, whether they receive less care after acute ischemic stroke (AIS) is unknown. We compared receipt of guideline-concordant procedures after AIS between older adults with pre-existing MCI and normal cognition. METHODS: Prospective study of 591 adults ≥65 hospitalized for AIS between 2000 and 2014, and followed through 2015 using data from the nationally representative Health and Retirement Study, Medicare and American Hospital Association. We assessed pre-existing MCI (modified Telephone Interview for Cognitive Status score of 7-11) and normal cognition (score of 12-27). Primary outcome was a composite quality measure representing the number of 4 procedures (carotid imaging, cardiac monitoring, echocardiogram, and rehabilitation assessment) received within 30 days after AIS (ordinal scale with values of 0, 1, 2, 3-4). RESULTS: Among survivors of AIS, 26.9% had pre-existing MCI (62.9% were women, with a mean [SD] age of 82.4 [7.7] years), and 73.1% had normal cognition (51.4% were women, with a mean age of 78.4 [7.2] years). Patients with pre-existing MCI, compared to cognitively normal patients, had 39% lower cumulative odds of receiving the composite quality measure (unadjusted cumulative odds ratio, OR, 0.61 [95% CI, 0.43-0.87]; P=0.006). However, this association became non-significant after adjusting for patient and hospital factors (adjusted cumulative OR, 0.83 [95% CI, 0.56-1.24]; P=0.37). Lower cumulative odds of receiving the composite quality measure were associated with older patient age (adjusted cumulative OR per 1-year older age, 0.97 [95% CI, 0.95-0.99]; P=0.01) and Southern hospitals (adjusted cumulative OR for South vs North, 0.54 [95% CI, 0.31-0.94]; P=0.03). CONCLUSIONS: Differences in receipt of guideline-concordant procedures after AIS exist between patients with pre-existing MCI and normal cognition. These differences were largely explained by patient and regional factors associated with receiving less AIS care.


Assuntos
Envelhecimento/psicologia , Isquemia Encefálica/terapia , Cognição , Disfunção Cognitiva/psicologia , Disparidades em Assistência à Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
14.
PLoS One ; 15(8): e0232862, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810143

RESUMO

Cognitive impairments can be a significant problem after a traumatic brain injury (TBI), which affects millions worldwide each year. There is a need for establish reproducible cognitive assays in rodents to better understand disease mechanisms and to develop therapeutic interventions towards treating TBI-induced impairments. Our goal was to validate and standardize the radial arm water maze (RAWM) test as an assay to screen for cognitive impairments caused by TBI. RAWM is a visuo-spatial learning test, originally designed for use with rats, and later adapted for mice. The present study investigates whether test procedures, such us the presence of extra-maze cues influences learning and memory performance. C57BL/6 mice were tested in an 8-arm RAWM using a four-day protocol. We demonstrated that two days of training, exposing the mice to extra-maze cues and a visible platform, influenced learning and memory performance. Mice that did not receive training performed poorer compared to mice trained. To further validate our RAWM protocol, we used scopolamine. We, also, demonstrated that a single mild closed head injury (CHI) caused deficits in this task at two weeks post-CHI. Our data supported the use of 7 trials per day and a spaced training protocol as key factor to unmask memory impairment following CHI. Here, we provide a detailed standard operating procedure for RAWM test, which can be applied to a variety of mouse models including neurodegenerative diseases and pathology, as well as when pharmacological approaches are used.


Assuntos
Concussão Encefálica/psicologia , Aprendizagem em Labirinto , Animais , Concussão Encefálica/complicações , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Sinais (Psicologia) , Modelos Animais de Doenças , Feminino , Humanos , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Testes de Memória e Aprendizagem , Camundongos , Camundongos Endogâmicos C57BL , Antagonistas Muscarínicos/farmacologia , Testes Neuropsicológicos , Escopolamina/farmacologia
15.
Psychogeriatrics ; 20(5): 726-736, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32767414

RESUMO

AIM: Many researchers argue that Alzheimer's disease is at least partly caused by deposition of amyloid beta (Aß) in the brain. Ferulic acid (FA) and Angelica archangelica (AA) are candidate agents for reducing Aß and improving cognitive function. Feru-guard 100M is a supplement containing FA and AA extract. Using this supplement, we planned to assess the effect of FA and AA on Aß deposition in the human brain. METHODS: This was an open-label, interventional multi-institutional joint study of Kobe University and the Institute of Biomedical Research and Innovation (Kobe, Japan). Seventeen subjects diagnosed with mild cognitive impairment were divided into two groups: the intervention group (n = 10) and the control group (n = 7). The subjects in the intervention group used Feru-guard 100M every day for 48 weeks, whereas the subjects in the control group did not use the supplement. We assessed the differences between the two groups by examining Aß deposition and brain atrophy at 48 weeks and cognitive function every 24 weeks. We used carbon-11-labelled Pittsburgh compound B (PiB) positron emission tomography to evaluate Aß deposition. RESULTS: There were no significant differences in Aß deposition, brain atrophy, and cognitive function between the two groups. Specifically, differences in Aß deposition change in seven regions of interest examined with PiB positron emission tomography, brain atrophy change in four indicators of voxel-based morphometry, and cognitive impairment measured by five psychological tests were not significantly between the two groups. CONCLUSION: Treatment with Feru-guard 100M, a supplement containing FA and AA extract, for 48 weeks did not reduce cortical PiB retention, which reflects Aß deposition. It also did not suppress the aggravation of brain atrophy or decline in cognitive function.


Assuntos
Peptídeos beta-Amiloides/efeitos dos fármacos , Angelica archangelica/química , Encéfalo/patologia , Disfunção Cognitiva/diagnóstico , Ácidos Cumáricos/uso terapêutico , Idoso , Doença de Alzheimer/etiologia , Doença de Alzheimer/psicologia , Peptídeos beta-Amiloides/metabolismo , Compostos de Anilina , Atrofia , Encéfalo/diagnóstico por imagem , Radioisótopos de Carbono , Disfunção Cognitiva/diagnóstico por imagem , Progressão da Doença , Feminino , Humanos , Japão , Masculino , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Tiazóis
16.
BMC Infect Dis ; 20(1): 574, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32758161

RESUMO

BACKGROUND: Despite widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive disorder (HAND) and HIV-associated myelopathy (HAM) are not showing significant reduction in there occurrence. The HAM is a progressive myelopathy that often occur synchronously with severe form of the HAND in patients' having advanced immunosuppression. However, co-existence of less severe form of the HAND and HAM in patient with relatively preserved CD4 cells is rarely reported clinical entity in post cART era. CASE PRESENTATION: We report a 16-year old male, acquired HIV infection vertically, was on second line regimen because of virological failure since 3 years. His current CD4 lymphocyte count is 835 cells/uL with viral RNA level of 33,008 copies/mL. Currently presented with progressive forgetfulness, gait imbalance, and a frequent staring episodes without loss of postural tone. Neurological examination was pertinent for cognitive dysfunction with score of 6 on International HIV Dementia Scale (motor speed = 3, psychomotor speed = 2, and memory recall = 1). Lower limbs power is 4-/5, increased deep tendon reflexes, and unsteady gait. Brain MRI revealed diffuse both cortical and white matter T2 and FLAIR hyperintense lesions. Thoracic MRI showed abnormal T2 signal prolongation spanning from mid thoracic cord to conus. Electroencephalography study showed severe generalized slowing with evidence of focal dysrhythmia in bilateral frontotemporal regions. Unremarkable serum vitamin B 12 level (286 ng/mL). Virological failure with the HAND, HAM and seizure was considered. Dolutegravir +3TC + ATV/r regimen and valproate for seizure disorder was started. On 6 months follow up evaluation, he is clinically stable with significant improvement of his symptoms related to seizure disorders and modest improvement of his cognitive dysfunction, as he is now attending his school regularly. However, less improvement was observed reading his gait abnormality. CONCLUSION: This case supports the current understanding regarding the persistent occurrence of HIV-associated neurocognitive disorder and HIV-associated myelopathy even decades after introduction of cART. Therefore, it's important to screen HIV+ patients for the HAND and HAM even if they have relatively preserved immunity. Because patient can be easily shifted to ART drugs with better CNS penetrating potential to achieve acceptable virological suppression level, to observe sound clinical improvement.


Assuntos
Complexo AIDS Demência/complicações , Complexo AIDS Demência/diagnóstico , Linfócitos T CD4-Positivos , Convulsões/complicações , Convulsões/diagnóstico , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico , Carga Viral , Complexo AIDS Demência/tratamento farmacológico , Complexo AIDS Demência/imunologia , Adolescente , Contagem de Linfócito CD4 , Disfunção Cognitiva/diagnóstico , Seguimentos , Inibidores de Integrase de HIV/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Humanos , Masculino , RNA Viral/sangue , Convulsões/tratamento farmacológico , Doenças da Medula Espinal/tratamento farmacológico , Resultado do Tratamento
17.
Curr Opin Anaesthesiol ; 33(6): 732-739, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32769745

RESUMO

PURPOSE OF REVIEW: The number and the complexity of procedures taking place at ambulatory surgery centers is steadily increasing. The rate at which medically complex patients, including those with baseline neurocognitive disorders, are undergoing ambulatory procedures is seeing a concurrent rise. Given the significant physical and psychological stress associated with surgery even in the ambulatory setting, it is essential to evaluate the ability of a patient to acclimate to stressful triggers in order to assess risk of subpar medical outcomes and increased mortality. In this review, we discuss recent advances in the assessment of both cognition and frailty and describe the implementation of these tools in the ambulatory surgery setting. RECENT FINDINGS: Recent Society for Perioperative Assessment and Quality Improvement (SPAQI) recommendations for evaluating at-risk patients focus on a two-pronged approach that encompasses screening for both impaired cognition and frailty. Screening should ideally occur as early as possible, but tools such as the Mini-Cog examination and FRAIL Questionnaire are efficient and effective even when used the day of surgery in high-risk patients. SUMMARY: The recognition of at-risk patients using standardized screening and the use of this assessment to guide perioperative monitoring and interventions is essential for optimizing outcomes for the complex ambulatory surgery patient.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Disfunção Cognitiva , Idoso Fragilizado , Fragilidade/complicações , Avaliação Geriátrica/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Medição de Risco/métodos , Idoso , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Fragilidade/diagnóstico , Humanos , Pacientes Ambulatoriais , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Inquéritos e Questionários
18.
Neurol Neurochir Pol ; 54(5): 440-448, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32808669

RESUMO

INTRODUCTION: Screening tests are a key step in the diagnosis of dementia and should therefore be highly sensitive to the detection of mild neurocognitive disorders (NCD). The Mini Mental State Examination (MMSE) is the most commonly used screening method. The Montreal Cognitive Assessment (MoCA) is a newer and less well-known screening tool, which has none of the limitations of the MMSE. AIM: The aim of this study was to analyse the reliability of the Polish versions of MoCA 7.2 vs MMSE in the detection of mild NCD among people aged over 60. MATERIAL AND METHODS: The study was carried out at the Department and Clinic of Geriatrics from September 2014 to March 2017. The study included 281 participants, 91 of whom were assigned to the group without NCD. The other 190 had been diagnosed with mild NCD. RESULTS: In the analysis of the ROC curve of the MoCA 7.2 results, the AUC was 0.925 (p < 0.001). The optimal cut-off point for mild NCD was 23/24 points, with sensitivity and specificity of 83.2% and 79.1%. In the ROC curve of MMSE results, the AUC was 0.847 (p < 0.001). The optimal cut-off point for mild NCD was 27/28 points, with sensitivity and specificity of 75.8% and 66.7%. The difference between AUC MoCA 7.2 and MMSE was 0.078 (p = 0.036). CONCLUSIONS: MoCA 7.2 detects mild NCD with more sensitivity than MMSE. We recommend using the cut-off point for MoCA of 23/24 points, because this is characterised by a higher sensitivity than the previously recommended cut-off point of 25/26 points. For the MMSE, the recommended cut-off point should be 27/28, which gives greater diagnostic accuracy than the previously recommended 25/26 points.


Assuntos
Disfunção Cognitiva , Demência , Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Humanos , Testes de Estado Mental e Demência , Testes Neuropsicológicos , Polônia , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
19.
J Stroke Cerebrovasc Dis ; 29(9): 105027, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807442

RESUMO

BACKGROUND: Cognitive impairment is common after aneurysmal subarachnoid hemorrhage (SAH). However, compared to predictors of functional outcome, meaningful predictors of cognitive impairment are lacking. OBJECTIVE: Our goal was to assess which factors during hospitalization can predict severe cognitive impairment in SAH patients, especially those who might otherwise be expected to have good functional outcomes. We hypothesized that the degree of early brain injury (EBI), vasospasm, and delayed neurological deterioration (DND) would predict worse cognitive outcomes. METHODS: We retrospectively reviewed SAH patient records from 2013 to 2019 to collect baseline information, clinical markers of EBI (Fisher, Hunt-Hess, and Glasgow Coma scores), vasospasm, and DND. Cognitive outcome was assessed by Montreal Cognitive Assessment (MoCA) and functional outcomes by modified Rankin Scale (mRS) at hospital discharge. SAH patients were compared to non-neurologic hospitalized controls. Among SAH patients, logistic regression analysis was used to identify predictors of severe cognitive impairment defined as a MoCA score <22. RESULTS: We screened 288 SAH and 80 control patients. Cognitive outcomes assessed via MoCA at discharge were available in 105 SAH patients. Most of these patients had good functional outcome at discharge with a mean mRS of 1.8±1.3. Approximately 56.2% of SAH patients had MoCA scores <22 compared to 28.7% of controls. Among SAH patients, modified Fisher scale was an independent predictor of cognitive impairment after adjustment for baseline differences (OR 1.638, p=0.043). MoCA score correlated inversely with mRS (r=-0.3299, p=0.0006); however, among those with good functional outcome (mRS 0-2), 48.7% still exhibited cognitive impairment. CONCLUSIONS: Severe cognitive impairment is highly prevalent after SAH, even among patients with good functional outcome. Higher modified Fisher scale on admission is an independent risk factor for severe cognitive impairment. Cognitive screening is warranted in all SAH patients, regardless of functional outcome.


Assuntos
Cognição , Disfunção Cognitiva/etiologia , Hemorragia Subaracnóidea/complicações , Adulto , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/psicologia , Avaliação da Deficiência , Feminino , Nível de Saúde , Humanos , Masculino , Saúde Mental , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/fisiopatologia , Hemorragia Subaracnóidea/psicologia , Fatores de Tempo
20.
J Cross Cult Gerontol ; 35(3): 237-254, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32725292

RESUMO

Psychosocial, socioeconomic and sociocultural aspects can influence cognitive function among community-dwelling older adults. Life-space restriction is potentially related to cognitive status. We examined the longitudinal association between life-space mobility and changes in cognitive function in community-dwelling older adults in different social settings of North and South America and Europe. We used data from 1486 participants of the International Mobility in Aging Study (IMIAS) conducted at five sites: Tirana (Albania), Natal (Brazil), Manizales (Colombia), Kingston and Saint-Hyacinthe (Canada). Life-space mobility was assessed using the Life-Space Assessment (LSA) questionnaire at baseline (2012), and the Leganes Cognitive Test was used to evaluate cognitive function at baseline and follow-up (2016). The Quantile regressions (QR) were used to evaluate the factors associated with cognitive score in 2016 by adjusting for the cognitive score in 2012, with two distinct models for analyzing variables. A decrease in the cognitive function was observed at all research sites, except in Manizales. Participants with more restricted life-space at baseline had a decrease in their cognitive function 4 years later (ß = -0.79, 95% CI: -1.400 to -0.18, p value<0.01) compared to those with the highest level. This decrease was independent of gender, age, research site, education, income sufficiency, social support, depression, cognitive function at baseline, chronic conditions and physical performance. Restriction in life-space is an important prognostic factor for cognitive function. Maintaining life-space can be a goal in public policies aimed at encouraging healthy aging, and might be useful in clinical practice to promote health status and to monitor older people at higher risk of cognitive decline.


Assuntos
Disfunção Cognitiva/diagnóstico , Vida Independente/psicologia , Limitação da Mobilidade , Idoso , Albânia , Brasil , Canadá , Colômbia , Feminino , Avaliação Geriátrica/métodos , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Fatores Sexuais , Apoio Social , Fatores Socioeconômicos
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