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1.
Neurol Sci ; 42(2): 455-465, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33409824

RESUMO

INTRODUCTION: Healthy elderly, mild cognitive impairment and Alzheimer's disease populations have been among the most affected in the early stages of the COVID-19 pandemic due to the direct effects of the virus, and numerous indirect effects now emerge and will have to be carefully assessed over time. METHODS: This article reviews the main articles that have been published so far about the direct and indirect effects of the COVID-19 pandemic on these particularly fragile populations. RESULTS: The pandemic associated to COVID-19 has shifted most of the health resources to the emergency area and has consequently left the three main medical areas dealing with the elderly population (oncology, time-dependent diseases and degenerative disease) temporarily "uncovered". In the phase following the emergency, it will be crucial to guarantee to each area the economic and organizational resources to quickly return to the level of support of the prepandemic state. CONCLUSIONS: The emergency phase represented a significant occasion of discussion on the possibilities of telemedicine which will inevitably become increasingly important, but all the limits of its use in the elderly population have to be considered. In the post-lockdown recovery phase, alongside the classic medical evaluation, the psychological evaluation must become even more important for doctors caring about people with cognitive decline as well as with their caregivers.


Assuntos
Envelhecimento , Doença de Alzheimer , Disfunção Cognitiva , Assistência à Saúde , Recursos em Saúde , Doença de Alzheimer/terapia , Disfunção Cognitiva/terapia , Humanos
2.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431450

RESUMO

An 83-year-old woman was referred to hospital with a 2-week history of short-lived episodic unpleasant sensations in her head and running down her body. This was accompanied by new short-term memory impairment and arm spasms. Initial investigations including blood tests and brain imaging did not reveal the diagnosis. The patient developed an increasing frequency of abnormal movements of her face and arm. These were clinically recognised as faciobrachial dystonic seizures (FBDS). FBDS are pathognomonic of an autoimmune encephalitis caused by an antibody directed against leucine-rich glioma-inactivated 1 (LGI1). The clinical diagnosis resulted in treatment with immunotherapy, leading to cessation of seizures and rapid cognitive recovery. Later, the predicted serology was confirmed. This reversible and under-recognised cause of cognitive impairment, typically affecting elderly patients, can be diagnosed clinically to enable early and effective treatment.


Assuntos
Autoanticorpos/sangue , Disfunção Cognitiva/imunologia , Imunoterapia/métodos , Encefalite Límbica/diagnóstico , Convulsões/imunologia , Administração Intravenosa , Idoso de 80 Anos ou mais , Autoanticorpos/imunologia , Disfunção Cognitiva/terapia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Peptídeos e Proteínas de Sinalização Intracelular/imunologia , Encefalite Límbica/complicações , Encefalite Límbica/imunologia , Encefalite Límbica/terapia , Sistema Límbico/diagnóstico por imagem , Sistema Límbico/imunologia , Metilprednisolona/administração & dosagem , Troca Plasmática , Tomografia por Emissão de Pósitrons , Convulsões/terapia , Resultado do Tratamento
3.
Med Clin North Am ; 105(1): 75-91, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246524

RESUMO

The primary care physician is well positioned to identify and treat patients with cognitive impairment (CI). Simple, validated tools can screen for CI in the office. Identifying the type of dementia and stage of the disease helps to guide care. A thorough history, medication review, physical examination, laboratory workup, and imaging studies can help identify specific causes contributing to memory loss. A patient-centered, multidisciplinary team approach includes nonpharmacological and pharmacologic treatments. Patient safety and preservation of functional status should be at the forefront of caring for the forgetful patient.


Assuntos
Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/terapia , Disfunção Cognitiva/etiologia , Demência/classificação , Demência/diagnóstico , Humanos , Anamnese , Medicare , Neuroimagem , Testes Neuropsicológicos , Equipe de Assistência ao Paciente , Exame Físico , Atenção Primária à Saúde , Encaminhamento e Consulta , Estados Unidos
4.
Arch Gerontol Geriatr ; 93: 104319, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33338831

RESUMO

OBJECTIVES: Considering dementia has no definite curative intervention available through modern medical management, alternative therapeutic symptomatic interventions are needed urgently. This systematic review with meta-analysis evaluated whether yoga-related practices, as a preventive mind-body therapy, is effective for the management of cognitive decline in older adults. METHODS: Seven electronic databases (Abstracts in Social Gerontology, Age Line, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science) were searched using specified inclusion criteria to identify original studies that investigated the effects of yoga-related mind-body therapies on cognitive function, in the context of aging. A meta-analysis was also carried out calculating the overall effect sizes, expressed as standardized mean differences (i.e., d). RESULTS: Twelve studies, including 912 participants (73.9% female; 239 with and 673 without cognitive impairment) were selected for this review; eleven were randomized controlled trials. One study had a high risk of bias and was excluded from the meta-analysis. Studies involved a wide variety of yoga practices with a common focus on meditative postural exercises. Results revealed significant beneficial effects on memory (Cohen's d = 0.38), executive function (Cohen's d = 0.40), and attention and processing speed (Cohen's d = 0.33). No adverse effects were reported. DISCUSSION: Yoga-related mind-body interventions for older adults appear to be safe, feasible, and effective alternative practice for maintenance of cognitive functions both in age- and disease-related cognitive decline. Practicing yoga can be a useful part of daily routine to maintain cognitive function in older adulthood. Suggestions for further research were discussed.


Assuntos
Disfunção Cognitiva , Ioga , Adulto , Idoso , Cognição , Disfunção Cognitiva/terapia , Terapia por Exercício , Feminino , Humanos , Masculino , Memória
5.
Medicine (Baltimore) ; 99(51): e23803, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371155

RESUMO

INTRODUCTION: Post-stroke cognitive impairment (PSCI), which has a high morbidity, is closely associated with the recurrence and rehabilitation of ischemic stroke. There are 2 different stages of PSCI, including post-stroke cognitive impairment with no dementia (PSCIND) and post-stroke dementia (PSD). The latter has a significantly higher mortality rate than the previous one. Therefore, preventing the onset of PSD is of vital importance. However, there is no unequivocally effective prevention or treatment for PSCI, except intensive secondary prevention of stroke. The primary aim of this protocol is to explore whether acupuncture can improve cognitive function of patients with PSCIND and reduce the chances of developing PSD. On this bias, we also want to explore its possible mechanisms. METHODS AND ANALYSIS: A prospective, multicenter, large sample, randomized controlled trial will be conducted. A total of 360 eligible patients will be recruited from 5 different hospitals and randomly allocated into the acupuncture group (AG), sham acupuncture group (NAG), and waiting-list group (WLG) in a 1:1:1 ratio. The intervention period of NAG and AG will last 3 months (30 minutes per day, 3 times per week). Primary and secondary outcomes will be measured at baseline, 12 weeks (at the end of the intervention), 24 weeks (after the 12-week follow-up period), and 36 weeks (after the 24-week follow-up period). Resting-state and task-state functional MRI will be conducted at baseline and 12 weeks. ETHICS AND DISSEMINATION: The ethic committee of First Teaching Hospital of University of Traditional Chinese Medicine approved the study. Study results will be first informed to each participant and later disseminated to researchers, and the general public through courses, presentations and the internet, regardless of the magnitude or direction of effect. The results will also be documented in a published peer-reviewed academic journal. REGISTRATION: We have registered at ClinicalTrials.gov(ChiCTR2000033801).


Assuntos
Terapia por Acupuntura/normas , Disfunção Cognitiva/terapia , Acidente Vascular Cerebral/complicações , Terapia por Acupuntura/métodos , Terapia por Acupuntura/estatística & dados numéricos , China , Disfunção Cognitiva/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Estudos Prospectivos , Estatísticas não Paramétricas , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/métodos , Fatores de Tempo , Resultado do Tratamento
6.
Artigo em Inglês | MEDLINE | ID: mdl-33317169

RESUMO

(1) Background: The purpose of this meta-analysis is to investigate the effects of exercise intervention for older adults with mild cognitive impairment (MCI). (2) Methods: Databases including PubMed, Medline, and Cochrane were used to search for studies that reported effects of exercise for older adults with MCI and randomized controlled trials up to July 2020. Exercise interventions of all selected studies were summarized, and effect sizes of exercise interventions were calculated. (3) Results: A total of 14 studies, including 1178 older adults with MCI were included. Exercise participation in older adults with MCI improved cognitive functions (d = 0.88, 95% confidence interval [CI]; 0.10-1.65, p = 0.01; k = 5]) and handgrip strength (d = 0.62, 95% [CI]; 0.23-1.01, p = 0.00; k = 4) compared with control groups. Aerobic exercise or resistance exercise at moderate to vigorous levels for at least 150 min, 1 time/week, for 6 weeks was the minimum level to obtain beneficial effects from exercise for older adults with MCI. (4) Conclusions: Older adults with MCI who participated in exercise received beneficial effects, including improvement in cognitive functions and handgrip strength, but further studies to confirm the effects are needed.


Assuntos
Adaptação Fisiológica , Disfunção Cognitiva , Terapia por Exercício , Idoso , Cognição , Disfunção Cognitiva/terapia , Força da Mão , Humanos
7.
Medicine (Baltimore) ; 99(46): e22956, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181659

RESUMO

INTRODUCTION: Mild cognitive impairment (MCI) is cognitive decline which can be observed in a wide range of cognitive domains. It is considered as a prodromal stage of dementia; therefore, strategies for treatment are necessary, but current evidence is limited. Combining the memory enhancing effect of Hominis placenta (H placenta) and acupuncture elucidated separately in previous studies, efficacy of H placenta pharmacopuncture for treating MCI is anticipated. METHODS: Thirty participants will be recruited. Male and female adults aged 50 to 80 who voluntarily participate in the trial, are diagnosed with MCI according to diagnostic and statistical manual of mental disorders-5 criteria, and have a Clinical Dementia Rating score 0.5 will be enrolled. Participants who meet the criteria will be randomly allocated to either pharmacopuncture group or control group. Participants will undergo H placenta pharmacopuncture or saline pharmacopuncture in GV20, ST36, and CV12 twice weekly for 8 weeks and will be evaluated a month after the last treatment. Primary outcome will be difference in mean change of Korean version of Montreal Cognitive Assessment scores between intervention group and control group. Cognition, mood, sleep quality and quality of life will be also assessed using other neuropsychological tests and questionnaires regarding depression, anxiety, sleep and quality of life. DISCUSSION: Evaluating the efficacy and safety data obtained by assessing diverse aspects of patients with MCI will broaden the scope of MCI management and prevention of dementia progression. TRIAL REGISTRATION: Clinical Research Information Service (KCT0005368), Registered 02 Sep 2020, https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=16425.


Assuntos
Terapia por Acupuntura/métodos , Disfunção Cognitiva/terapia , Extratos Placentários/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Testes Neuropsicológicos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
Australas J Ageing ; 39(3): 283-286, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33051999

RESUMO

OBJECTIVE: We developed interim guidance for the care of patients with cognitive impairment in hospital during the COVID-19 pandemic. METHODS: A Guidance Committee and Readers Group were recruited. The content was identified by the Committee and content-specific subgroups, resulting in a draft document, which was sent to the Readers for review. People with dementia and care partners were involved in all aspects of the process. RESULTS: Infection control measures can lead to an escalation of distress. In an environment where visiting bans are applied to care partners/advocates, hospitals need to ensure care partners can continue to provide decision-making support. Health-care professionals can proactively engage care partners using videoconferencing technologies. Developing models of care that proactively support best practice can minimise the risk of delirium, mitigate escalating symptoms and guide the use of non-pharmacological, pharmacological (start low, go slow) or physical restraint in managing behavioural and psychological symptoms.


Assuntos
Betacoronavirus , Disfunção Cognitiva/psicologia , Disfunção Cognitiva/terapia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Adulto , Austrália , Infecções por Coronavirus/transmissão , Hospitalização , Humanos , Pneumonia Viral/transmissão
9.
J Stroke Cerebrovasc Dis ; 29(11): 105217, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066895

RESUMO

BACKGROUND AND PURPOSE: We aimed to demonstrate the tolerability and feasibility and the effect of remote ischemic post-conditioning on cognitive functioning in patients with post-stroke cognitive impairment. METHODS: This was a single-center, randomized, outcome-blinded, placebo-controlled trial, randomized 1:1 to receive 4 cycles of remote ischemic post-conditioning or a sham procedure for 7 days. The primary outcome measure was tolerability and feasibility of remote ischemic post-conditioning. Secondary outcomes to measure the neurological function with national institute of health stroke scale and the cognitive impairment with Montreal Cognitive Assessment scale and Alzheimer's disease assessment scale-cognitive (at baseline, 90 days, 180 days). RESULTS: 48 patients (24 RIPC and 24 Control) were recruited. remote ischemic post-conditioning was well tolerated with 90 out of 96 cycles completed in full. 4 patients experienced vascular events in the control group: 3 cerebrovascular and 1 cardiovascular event versus only 2 cerebrovascular events in the RIPC group. We showed the similar result in the neurological function with national institute of health stroke scale score with no statistically significant differences between RIPC and control group at baseline (P = 0.796) and 90 days (P = 0.401) and 180 days (P = 0.695). But compare with baseline, it was significantly difference in the control and RIPC group at 90 days (P < 0.05) and 180 days (P < 0.05). The comparison of Montreal Cognitive Assessment scale between two groups both showed that P > 0.05 at baseline which was no statistical difference, but P < 0.05 at 90 days and 180 days which were significant statistical difference. The comparison of Alzheimer's disease assessment scale-cognitive between two groups showed that P > 0.05 at baseline (P = 0.955) and 90 days (P = 0.138) was no statistical difference, but P = 0.005<0.05 at 180 days was significant statistical difference. CONCLUSIONS: The remote ischemic post-conditioning for post-stroke cognitive impairment was well tolerated, safe and feasible. The remote ischemic post-conditioning may improve neurological and cognitive outcomes in patients with post-stroke cognitive impairment. A larger trial is warranted. (Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: ChiCTR1800015231.).


Assuntos
Cognição , Disfunção Cognitiva/terapia , Pós-Condicionamento Isquêmico , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , China , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Estudos de Viabilidade , Feminino , Humanos , Pós-Condicionamento Isquêmico/efeitos adversos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(36): e22021, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899055

RESUMO

BACKGROUND: Mild cognitive impairment (MCI) in the elderly is a health problem worldwide. Several clinical trials indicated that traditional Chinese medicine (TCM) exercise therapies can effectively improve MCI, such as Tai Ji, Baduan jin exercise, Liuzi jue, and finger exercise. However, there is still controversy over which therapy is the best for elderly MCI patients. In this study, we aimed to systematically evaluate and compare the effectiveness and safety of these 4 TCM exercise therapies in elderly patients with MCI. METHODS: The Web of Science, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Clinical Trials, China National Knowledge Infrastructure, Wangfang database, and Chinese Biomedical Medicine will be comprehensively searched to collect all randomized controlled trials which included elderly participants with MCI receiving TCM exercise therapies through July 2020. Two reviewers will independently screen and evaluate each included study and extract the outcome indexes. ADDIS 1.16.8 software will be used for the network meta-analysis and STATA 14 software will be used for drawing network evidence plots and funnel plots. RESULTS: We will use the Bayesian statistical model to conduct a network meta-analysis to rank the effectiveness and safety of these 4 interventions, and use the GRADE approach to interpret the results. CONCLUSION: This network meta-analysis will find out the optimal treatment plan for MCI and provide evidence-based bias for clinical treatments decision-making. PROTOCOL REGISTRATION NUMBER: INPLASY202070006.


Assuntos
Disfunção Cognitiva/terapia , Terapia por Exercício/métodos , Medicina Tradicional Chinesa/métodos , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Terapia Combinada , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência/normas , Pessoa de Meia-Idade , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Tai Ji/métodos , Resultado do Tratamento
11.
PLoS Comput Biol ; 16(9): e1008186, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32941425

RESUMO

Identifying heterogeneous cognitive impairment markers at an early stage is vital for Alzheimer's disease diagnosis. However, due to complex and uncertain brain connectivity features in the cognitive domains, it remains challenging to quantify functional brain connectomic changes during non-pharmacological interventions for amnestic mild cognitive impairment (aMCI) patients. We present a quantitative method for functional brain network analysis of fMRI data based on the multi-graph unsupervised Gaussian embedding method (MG2G). This neural network-based model can effectively learn low-dimensional Gaussian distributions from the original high-dimensional sparse functional brain networks, quantify uncertainties in link prediction, and discover the intrinsic dimensionality of brain networks. Using the Wasserstein distance to measure probabilistic changes, we discovered that brain regions in the default mode network and somatosensory/somatomotor hand, fronto-parietal task control, memory retrieval, and visual and dorsal attention systems had relatively large variations during non-pharmacological training, which might provide distinct biomarkers for fine-grained monitoring of aMCI cognitive alteration. An important finding of our study is the ability of the new method to capture subtle changes for individual patients before and after short-term intervention. More broadly, the MG2G method can be used in studying multiple brain disorders and injuries, e.g., in Parkinson's disease or traumatic brain injury (TBI), and hence it will be useful to the wider neuroscience community.


Assuntos
Encéfalo , Disfunção Cognitiva , Diagnóstico por Computador/métodos , Distribuição Normal , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/terapia , Conectoma , Humanos , Imagem por Ressonância Magnética , Memória/fisiologia , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Aprendizado de Máquina não Supervisionado
12.
Lancet Neurol ; 19(10): 860-871, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32949546

RESUMO

Multiple sclerosis is a chronic, demyelinating disease of the CNS. Cognitive impairment is a sometimes neglected, yet common, sign and symptom with a profound effect on instrumental activities of daily living. The prevalence of cognitive impairment in multiple sclerosis varies across the lifespan and might be difficult to distinguish from other causes in older age. MRI studies show that widespread changes to brain networks contribute to cognitive dysfunction, and grey matter atrophy is an early sign of potential future cognitive decline. Neuropsychological research suggests that cognitive processing speed and episodic memory are the most frequently affected cognitive domains. Narrowing evaluation to these core areas permits brief, routine assessment in the clinical setting. Owing to its brevity, reliability, and sensitivity, the Symbol Digit Modalities Test, or its computer-based analogues, can be used to monitor episodes of acute disease activity. The Symbol Digit Modalities Test can also be used in clinical trials, and data increasingly show that cognitive processing speed and memory are amenable to cognitive training interventions.


Assuntos
Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/psicologia , Gerenciamento Clínico , Imagem por Ressonância Magnética/métodos , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/psicologia , Adolescente , Idoso de 80 Anos ou mais , Disfunção Cognitiva/terapia , Feminino , Humanos , Esclerose Múltipla/terapia
13.
Medicine (Baltimore) ; 99(39): e22365, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991455

RESUMO

BACKGROUND: Acupuncture has an unique role in preventing and managing mild cognitive impairment (MCI) in nonpharmaceutical therapies because of its small wound, mild pain, and high security for many years. However, there is no systematic review evaluating safety and efficacy of acupuncture for MCI in elderly people. Therefore, this study will provide a protocol to explore the effectiveness and safety of acupuncture for MCI in the elderly. METHODS: Retrieval from 8 electronic databases was conducted to determine eligible trials published until May, 2019. Homogeneity qualified studies were included for data were extracted such as study country location, demographic characteristics, and measure outcomes, and were analyzed by a random effect model and sensitivity analyses to identify heterogeneity. Review Manager (Revman Version 5.3) software will be used for data synthesis, sensitivity analysis, meta regression, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias. RESULTS: A total of 15 randomized control trials involving 1051 subjects were included. The results were as follows: Compared with the control group, the clinical efficacy rates of acupuncture was better, odds ratio = 2.52, 95% confidence interval (CI) (1.86, 3.42), P < .00001, mini-mental state examination scores (mean difference [MD] = 1.53, 95% CI [1.04, 2.01], P < .00001), Montreal cognitive assessment scores (MD = 2.05, 95% CI [1.17, 1.92], P < .00001), activity of daily living scale (MD = 1.71, 95% CI [-1.38, 4.79], P > .05), and clock drawing task scores (MD = 1.91, 95% CI [1.74, 2.08], P < .00001). CONCLUSION: This study shows that acupuncture is beneficial for improving aspects of cognitive function in elderly people with MCI, which suggests that acupuncture may be an effective alternative and complementary approach to existing therapies for elderly people. More rigorous experimental studies and longer follow-up studies should be conducted in the future.


Assuntos
Terapia por Acupuntura/métodos , Disfunção Cognitiva/terapia , Atividades Cotidianas , Terapia por Acupuntura/efeitos adversos , Fatores Etários , Cognição , Humanos , Testes de Estado Mental e Demência , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores Sexuais , Fatores Socioeconômicos
14.
Medicine (Baltimore) ; 99(37): e22154, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925774

RESUMO

The cognitive function of nursing home (NH) residents with cognitive impairment (CI) tends to decline over time. An effective multimodal non-pharmacological intervention (MNPI) strategy is needed to improve the cognitive function of NH residents with CI.The aim of this study was to clarify the cognitive function characteristics of NH residents with CI in whom a non-pharmacological intervention (NPI) can be implemented, consisting of MNPI using a Bayesian analysis, and to incorporate suggestions to make the MNPI strategy as effective as possible.This study had a cross-sectional design. The 61 subjects were selected from the residents of 5 NHs, of whom 90.16% were female, and the mean (standard deviation) age was 87.20 ±â€Š6.90. Analyses were performed using a hierarchical Bayesian model, and the global and specific cognitive functions as assessed by the Japanese version of the Neurobehavioral Cognitive Status Examination were the response variables. Three types of NPI (cognitive enhancement NPI, physical NPI, psychological and psychosocial NPI), and activities of daily living (ADL), as assessed by the Barthel index, were the explanatory variables.Cognitive enhancement NPI was revealed to have no association with any cognitive function. Physical NPI was negatively associated with orientation [OR 0.31 (95% credible interval (95% CI) -2.33, -0.10)], comprehension [OR 0.16 (95% CI -2.78, -0.95)] and naming [OR 0.49 (95% CI -1.47, -0.02)]. Psychological and psychosocial NPI was positively associated with comprehension [OR 3.67 (95% CI 0.52, 2.13)]. Barthel index was positively associated with total Japanese version of the Neurobehavioral Cognitive Status Examination [OR 1.74 (95% CI 0.08, 2.12)], comprehension [OR 3.49 (95% CI 0.45, 4.67)], repetition [OR 10.07 (95% CI 0.53, 9.01)], naming [OR 2.24 (95% CI 0.07, 3.20)], and calculations [OR 18.82 (95% CI 2.71, 9.40)].The implementation of MNPI should be preceded by cognitive enhancement NPI and physical NPI. Providing ADL enhancing NPI in response to cognitive improvement may be an effective strategy. Providing cognitive enhancement NPI, physical NPI, psychological, and psychosocial NPI, as well as ADL-enhancing NPI at the same time, is also an effective strategy for subjects with mild dementia who are considered to have relatively high cognitive functions.


Assuntos
Disfunção Cognitiva/terapia , Instituição de Longa Permanência para Idosos , Casas de Saúde , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Teorema de Bayes , Terapia Combinada , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , Testes Neuropsicológicos , Participação Social
15.
Medicine (Baltimore) ; 99(37): e22187, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925791

RESUMO

BACKGROUND: Mild cognitive impairment (MCI) is an intermediate stage between normal aging and Alzheimer disease, which is the most common form of dementia in the world. In clinical practice, traditional Chinese medicine (TCM) interventions have been administered for MCI, However, there is still uncertain about what strategy of TCM interventions treatment should be preferred in clinical practice. This study aims to evaluate the efficacy and acceptability of different TCM therapies through systematic review and network meta-analysis. METHODS: According to the strategy, the authors will retrieve a total of 7 electronic databases by August 2020, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chongqing VIP, and Wan-fang databases. After a series of screening, 2 researchers will use Aggregate Data Drug Information System and Stata software to analyze the data extracted from the randomized controlled trials of TCM therapies for MCI. The primary outcome of this study is the improvement of cognitive function and the secondary outcome is the activities of daily living, clinical efficacy, and adverse events, and the quality of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation instrument. RESULTS: This study will provide a reliable evidence for the selection of TCM therapies in the treatment of MCI. CONCLUSION: This study will generate evidence for different TCM therapies for MCI and provide a decision-making reference for clinical research. ETHICS AND DISSEMINATION: This study does not require ethical approval. The results will be disseminated through a peer-reviewed publication. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/JV9KG.


Assuntos
Disfunção Cognitiva/terapia , Medicina Tradicional Chinesa/métodos , Atividades Cotidianas , Humanos , Medicina Tradicional Chinesa/efeitos adversos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
16.
Rev. neurol. (Ed. impr.) ; 71(6): 205-212, 16 sept., 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195513

RESUMO

INTRODUCCIÓN: En las últimas décadas, se ha incrementado exponencialmente la investigación sobre los efectos de la realidad virtual en diferentes trastornos neurológicos. Sin embargo, la bibliografía centrada en los beneficios de la realidad virtual sobre el deterioro cognitivo en personas mayores es limitada. OBJETIVO: Explorar la aplicación de la realidad virtual como herramienta preventiva, diagnóstica o de tratamiento del deterioro cognitivo en personas mayores. PACIENTES Y MÉTODOS: Se llevó a cabo una búsqueda bibliográfica en las bases de datos Medline y Web of Science, incluyendo toda la bibliografía publicada desde sus inicios hasta diciembre de 2019. RESULTADOS: De las 270 publicaciones encontradas, 15 cumplieron los criterios de inclusión: dos examinaron el efecto de la realidad virtual como herramienta de prevención del deterioro cognitivo; seis, su aplicabilidad diagnóstica; y siete, su efectividad como tratamiento. CONCLUSIONES: Existe evidencia del potencial efecto de la realidad virtual como estrategia preventiva frente al desarrollo de deterioro cognitivo en personas mayores. Existe también evidencia de su aplicabilidad como herramienta diagnóstica de detección de desarrollo de deterioro cognitivo leve o demencia, y de su efectividad como tratamiento, ya que mejora el funcionamiento cognitivo de personas mayores con deterioro cognitivo. Son necesarios futuros estudios metodológicamente más robustos y con amplios tiempos de seguimiento para examinar el impacto real de la realidad virtual y poder generalizar su aplicación en los diferentes ámbitos de manejo del deterioro cognitivo


INTRODUCTION: In recent decades, research into the effects of virtual reality on different neurological disorders has increased exponentially. Yet, the literature focused on the beneficial effects of virtual reality on cognitive impairment in elderly people is limited. AIM: To explore the application of virtual reality as a preventive, diagnostic or therapeutic tool for cognitive impairment in elderly people. PATIENTS AND METHODS: A literature search was conducted in the Medline and Web of Science databases, including all the literature published from their inception up until December 2019. RESULTS: Of the 270 publications found, 15 met the inclusion criteria: two examined the effect of virtual reality as a tool for the prevention of cognitive impairment, six looked at its possible applications in diagnosis, and seven explored its effectiveness as a form of treatment. CONCLUSIONS: There is evidence of the potential effect of virtual reality as a preventive strategy against the development of cognitive impairment in elderly people. There is also evidence of its applicability as a diagnostic tool for detecting the development of mild cognitive impairment or dementia, and of its effectiveness as a treatment, since it improves the cognitive functioning of elderly people with cognitive impairment. Further studies are needed that are more methodologically robust and have long follow-up times in order to examine the real impact of virtual reality and to be able to generalise its application in different areas of the management of cognitive impairment


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Realidade Virtual , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/terapia , Transtornos Cognitivos/prevenção & controle , Qualidade de Vida , Atividades Cotidianas
17.
Medicine (Baltimore) ; 99(31): e20105, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756073

RESUMO

OBJECTIVE: To conduct a meta-analysis and subgroup analysis investigating the effects of exercise on mild cognitive impairment (MCI) patients across specific cognitive domain outcomes. We also analyzed and identified the level of influence of exercise interventions on specific cognitive domains. METHODS: MEDLINE, EMBASE, Cochrane Library, Web of Science, CNKI, the Wan Fang Database, and CBM were searched from inception to April 2018. Randomized controlled trials of exercise interventions in MCI patients older than 55 years, with an outcome measure of cognitive function were included. RESULTS: Eleven studies with sufficient data met the inclusion criteria for the meta-analysis. Exercise interventions significantly improved general function (g mini-mental state examination Montreal cognitive assessment = 0.32, 95% the 95% confidence interval (CI) 0.1 to 0.54, P = .005 and g Alzheimer disease assessment scale-cognition = -0.45, 95% CI -0.82 to -0.08, P = .02); executive functions (g digit span forward test, digit span backward test, digit span forward test -B, stroop test-A, stroop test-B = 0.66, 95% CI 0.17 to 1.15, P = .008); memory (g Wechsler memory scale immediate recall and Wechsler memory scale delayed recall = 0.37, 95% CI 0.15 to 0.60, P = .001); language ability (g category verbal fluency test and letter verbal fluency test = 0.55, 95% CI 0.22 to 0.89, P = .001); and visuospatial ability (g block design score = 0.38, 95% CI 0.03 to 0.72, P = .03). However, the improvement exercise conferred on the trail-making test part B-A was not statistically significant (g trail-making test part B-A  = -0.25, 95% CI -0.88 to 0.39, P = .45). The preliminary ranking of the effect on the overall effect was as follows: Z language ability > Z executive functions >   memory > Z visuospatial ability. CONCLUSION: Exercise improves performance in the 5 cognitive domains. Across cognitive domains, language ability was the domain most affected by exercise. Besides, the kind of ranking (Z value) provides a new perspective for community health care workers to prescribe targeted exercise interventions for MCI patients.PROSPERO registration number: CRD42018093902.


Assuntos
Disfunção Cognitiva/terapia , Terapia por Exercício , Idoso , Cognição , Disfunção Cognitiva/psicologia , Função Executiva , Feminino , Humanos , Masculino , Rememoração Mental , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Artigo em Inglês | MEDLINE | ID: mdl-32823839

RESUMO

Disorders of communication, social relationships, and psychomotricity are often characterized by cognitive impairment, which hinders daily activities and increases the risk of falls. This study aimed to evaluate the efficacy of an animal-assisted therapy (AAT) program in an institutionalized geriatric population with cognitive impairment. The variables evaluated included level of communication and changes in gait and/or balance. We performed a two-arm, parallel controlled, open-label, nonrandomized cluster clinical trial in two nursing home centers from an urban area. Patients in the two centers received 12 weekly sessions of physiotherapy, but the experimental group included AAT with a therapy dog. The study included a total of 46 patients (23 Control Group [CG], 23 Experimental Group [EG]) with a median age of 85.0 years. Of these, 32.6% had mild-moderate cognitive decline (Global Deterioration Scale of Reisberg [GDS] 2-4) and 67.4% severe cognitive decline (GDS 5-6). After the intervention, patients in the CG and EG showed a statistically significant improvement in all the response variables. When comparing both groups, no statistically significant differences were found in any of the Tinetti scale results (measuring gait and balance). However, the communication of patients in the EG, measured on the Holden scale, showed a statistically significant greater improvement postintervention than that of patients in the CG. AAT can be useful as a complementary, effective treatment for patients with different degrees of cognitive decline.


Assuntos
Terapia Assistida com Animais , Disfunção Cognitiva/terapia , Demência , Idoso , Idoso de 80 Anos ou mais , Animais , Cães , Feminino , Humanos , Institucionalização , Masculino , Amplitude de Movimento Articular
20.
BMJ Open ; 10(8): e039305, 2020 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-32859666

RESUMO

INTRODUCTION: The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) randomised controlled trial (RCT) is evaluating a home-based, face-to-face, individually tailored, activity and exercise programme for people living with dementia. Social distancing requirements following the COVID-19 pandemic necessitated rapid changes to intervention delivery. METHODS AND ANALYSIS: A mixed-methods process evaluation will investigate how the changes were implemented and the impact that these have on participants' experience. An implementation study will investigate how the intervention was delivered during the pandemic. A study on the mechanisms of impact and context will investigate how these changes were experienced by the PrAISED participants, their carers and the therapists delivering the intervention. The study will commence in May 2020. ETHICS AND DISSEMINATION: The PrAISED RCT and process evaluation have received ethical approval number 18/YH/0059. The PrAISED process evaluation will enable us to understand how distancing and isolation affected participants, their activity and exercise routines and whether the therapy programme could be continued with remote support. This will be valuable both in explaining trial results and also contribute to understanding and designing new ways of delivering home-based services and rehabilitation interventions for people with dementia and their carers. TRIAL REGISTRATION NUMBER: ISRCTN15320670; Pre-results.


Assuntos
Disfunção Cognitiva/terapia , Infecções por Coronavirus , Demência/terapia , Exercício Físico , Promoção da Saúde , Vida Independente , Pandemias , Pneumonia Viral , Avaliação de Processos em Cuidados de Saúde , Atividades Cotidianas , Betacoronavirus , Cuidadores , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Terapia por Exercício , Feminino , Serviços de Assistência Domiciliar , Humanos , Masculino , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Projetos de Pesquisa , Isolamento Social
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