Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.419
Filtrar
1.
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
2.
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
3.
Medicine (Baltimore) ; 99(36): e21691, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899001

RESUMO

This retrospective study explored the efficacy and safety of dexmedetomidine in treating early postoperative cognitive dysfunction (EPPNCD) after video-assisted thoracoscopic lobectomy (VATL) in elderly male patients with lung cancer (LC).This study included a total of 80 elderly male patients with LC who received VATL. All of them were equally assigned to a treatment group and a control group, with 40 patients each group. The primary outcome included cognitive dysfunction, as evaluated by mini-mental state examination scale. The secondary outcomes consisted of incidence of EPPNCD, lung function (as measured by forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, and maximal voluntary ventilation), and adverse events. All outcome data were analyzed before and 3 days after surgery.After surgery, all patients in the treatment group exerted better efficacy in mini-mental state examination scale (P < .01) and incidence of EPPNCD (P = .03), than patients in the control group. However, no significant differences were detected in forced vital capacity (P = .65), forced expiratory volume in 1 second (P = .50), peak expiratory flow (P = .73), and maximal voluntary ventilation (P = .27) between 2 groups. In addition, there is similar safety profile between 2 groups.The findings of this study showed that dexmedetomidine may benefit EPPNCD after VATL in elderly male patients with LC. Future studies are needed to warrant the present conclusions.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Dexmedetomidina/administração & dosagem , Neoplasias Pulmonares/cirurgia , Complicações Cognitivas Pós-Operatórias/tratamento farmacológico , Cirurgia Torácica Vídeoassistida/efeitos adversos , Idoso , Analgésicos não Entorpecentes/efeitos adversos , Estudos Controlados Antes e Depois , Dexmedetomidina/efeitos adversos , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
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
5.
Medicine (Baltimore) ; 99(37): e22209, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925798

RESUMO

BACKGROUND: Vascular dementia has become the second most common type of dementia after Alzheimer disease. At present, there is no uniform standard for VaD treatment guidelines among countries. The efficacy of ginkgo biloba in the treatment of vascular dementia is still controversial. The purpose of this study is to evaluate the effectiveness and safety of ginkgo biloba in the treatment of vascular dementia through meta-analysis. METHODS: Six English databases (PubMed, Web of science, Medline, EBASE, Springer Cochrane Library, and WHO International Clinical Trials Registry Platform) and 4 Chinese databases (Wan fang Database, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database(CNKI) and Chinese Biomedical Literature Database) will be searched normatively according to the rule of each database from the inception to August 1, 2020. Two reviewers will independently conduct article selection, data collection, and risk of bias evaluation. Any disagreement will be resolved by discussion with the third reviewer. Either the fixed-effects or random-effects model will be used for data synthesis based on the heterogeneity test. The change in the scores on mini-mental state examination, activity of daily living scale and Montreal cognitive assement will be used as the main outcome measure, Hamilton depression scale, Hastgawa dementia scale, blessed dementia scale, clinical dmentia rating scale as the secondary outcome. Treatment emergent symptom scale, general physical examination (temperature, pulse, respiration, blood pressure), Routine examination of blood, urine and stool, electrocardiogram, liver and kidney function examination as the security indexs. RevMan5.3.5 will be used for meta-analysis. RESULTS: This study will provide high-quality evidence to assess the effectiveness and safety of ginkgo preparation for vascular dementia. CONCLUSION: This systematic review will explore whether ginkgo preparation is an effective and safe intervention for vascular dementia. ETHICS AND DISSEMINATION: Ethical approval are not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and will be shared on social media platforms. This review will be disseminated in a peer-reviewed journal or conference presentation. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020167851.


Assuntos
Demência Vascular/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Atividades Cotidianas , Demência Vascular/epidemiologia , Depressão/epidemiologia , Nível de Saúde , Humanos , Testes de Estado Mental e Demência , Extratos Vegetais/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
6.
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
7.
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
8.
Cochrane Database Syst Rev ; 8: CD010515, 2020 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-32786083

RESUMO

BACKGROUND: People with dementia living in the community, that is in their own homes, are often not engaged in meaningful activities. Activities tailored to their individual interests and preferences might be one approach to improve quality of life and reduce challenging behaviour. OBJECTIVES: To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in the community and their caregivers. To describe the components of the interventions. To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS: We searched ALOIS: the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 11 September 2019 using the terms: activity OR activities OR occupation* OR "psychosocial intervention" OR "non-pharmacological intervention" OR "personally-tailored" OR "individually-tailored" OR individual OR meaning OR involvement OR engagement OR occupational OR personhood OR "person-centred" OR identity OR Montessori OR community OR ambulatory OR "home care" OR "geriatric day hospital" OR "day care" OR "behavioural and psychological symptoms of dementia" OR "BPSD" OR "neuropsychiatric symptoms" OR "challenging behaviour" OR "quality of life" OR depression. ALOIS contains records of clinical trials identified from monthly searches of a number of major healthcare databases, numerous trial registries and grey literature sources. SELECTION CRITERIA: We included randomised controlled trials and quasi-experimental trials including a control group offering personally tailored activities. All interventions comprised an assessment of the participant's present or past interests in, or preferences for, particular activities for all participants as a basis for an individual activity plan. We did not include interventions offering a single activity (e.g. music or reminiscence) or activities that were not tailored to the individual's interests or preferences. Control groups received usual care or an active control intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently checked the articles for inclusion, extracted data, and assessed the methodological quality of all included studies. We assessed the risk of selection bias, performance bias, attrition bias, and detection bias. In case of missing information, we contacted the study authors. MAIN RESULTS: We included five randomised controlled trials (four parallel-group studies and one cross-over study), in which a total of 262 participants completed the studies. The number of participants ranged from 30 to 160. The mean age of the participants ranged from 71 to 83 years, and mean Mini-Mental State Examination (MMSE) scores ranged from 11 to 24. One study enrolled predominantly male veterans; in the other studies the proportion of female participants ranged from 40% to 60%. Informal caregivers were mainly spouses. In four studies family caregivers were trained to deliver personally tailored activities based on an individual assessment of interests and preferences of the people with dementia, and in one study such activities were offered directly to the participants. The selection of activities was performed with different methods. Two studies compared personally tailored activities with an attention control group, and three studies with usual care. Duration of follow-up ranged from two weeks to four months. We found low-certainty evidence indicating that personally tailored activities may reduce challenging behaviour (standardised mean difference (SMD) -0.44, 95% confidence interval (CI) -0.77 to -0.10; I2 = 44%; 4 studies; 305 participants) and may slightly improve quality of life (based on the rating of family caregivers). For the secondary outcomes depression (two studies), affect (one study), passivity (one study), and engagement (two studies), we found low-certainty evidence that personally tailored activities may have little or no effect. We found low-certainty evidence that personally tailored activities may slightly improve caregiver distress (two studies) and may have little or no effect on caregiver burden (MD -0.62, 95% CI -3.08 to 1.83; I2 = 0%; 3 studies; 246 participants), caregivers' quality of life, and caregiver depression. None of the studies assessed adverse effects, and no information about adverse effects was reported in any study. AUTHORS' CONCLUSIONS: Offering personally tailored activities to people with dementia living in the community may be one approach for reducing challenging behaviour and may also slightly improve the quality of life of people with dementia. Given the low certainty of the evidence, these results should be interpreted with caution. For depression and affect of people with dementia, as well as caregivers' quality of life and burden, we found no clear benefits of personally tailored activities.


Assuntos
Demência/reabilitação , Vida Independente , Preferência do Paciente , Qualidade de Vida , Participação Social , Idoso , Idoso de 80 Anos ou mais , Cuidadores/educação , Cuidadores/psicologia , Efeitos Psicossociais da Doença , Demência/psicologia , Depressão/reabilitação , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência/estatística & dados numéricos , Comportamento Problema/psicologia , Angústia Psicológica , Ensaios Clínicos Controlados Aleatórios como Assunto , Cônjuges/educação , Cônjuges/psicologia , Resultado do Tratamento
9.
Geriatr Gerontol Int ; 20(10): 860-866, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32830907

RESUMO

AIM: A better income condition has always been associated with better cognition; however, studies that have demonstrated the pathway of this relationship are limited. We aim to evaluate the mediation effect of depression in this association, and whether this mediation is moderated by the place of residence. METHODS: We conducted a face-to-face study, including 3230 older adults aged >60 years in Xiamen, China, in 2016. The income condition of participants was categorized into three groups: income less than expenditure, income equals expenditure and income more than expenditure. Depression was measured using the Geriatric Depression Scale and cognition was evaluated using the Montreal Cognitive Assessment tool. We first examined a simple mediation model where depression was a mediator between income condition and cognition. Furthermore, residence was systematically integrated into the model as a moderator, and the model was adjusted for age, gender, number of year of education, hypertension and diabetes. All mediation and moderated mediation effects were estimated by the plug-in "PROCESS" in SPSS. RESULTS: In total, 2852 participants were finally included. Depression partially mediated the relationship between income condition and cognition (indirect effect = 0.25, total effect = 0.72). Moderated mediation analyses indicated that a direct effect only existed among urban older adults (B = 0.92; 95% confidence interval [CI]: [0.47-1.38]), whereas an indirect effect was stronger for individuals in urban (B = 0.28; 95% CI: [0.18-0.41]) rather than rural environments (B = 0.17; 95% CI: [0.11-0.26]). CONCLUSIONS: A better income condition is a protective factor for cognition and it partially benefits work through milder depressive symptoms, particularly in older adults in urban residences. Geriatr Gerontol Int 2020; 20: 860-866.


Assuntos
Cognição , Depressão/epidemiologia , Renda/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Idoso , China/epidemiologia , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade
10.
Geriatr Gerontol Int ; 20(8): 779-784, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32618098

RESUMO

AIM: The perceived age of older adults, as measured by their facial appearance, has been shown to be a robust biomarker of aging predictive of survival, telomere length and DNA methylation, and reportedly correlates with carotid atherosclerosis and bone status. This study aimed to determine whether metrics of dementia, including general cognition, vitality, depressive state and self-supportability, have stronger correlations with perceived age than with chronological age. METHODS: This study included 124 patients who were admitted to the Department of Geriatric Medicine, The University of Tokyo Hospital, on account of being suspected of cognitive decline. The Mini-Mental State Examination, Vitality Index, Geriatric Depression Scale-15, instrumental activities of daily living and Barthel Index were carried out. Five experienced geriatricians and five experienced clinical psychologists determined the perceived age of participants based on photographs. RESULTS: The average values of the 10 raters showed excellent reliability (intraclass correlation coefficient (3, 10) = 0.941). Steiger's test revealed that perceived age showed a significantly better correlation with the Mini-Mental State Examination (female) and Vitality Index (total, female) than did chronological age, but not with Geriatric Depression Scale-15, instrumental activities of daily living or the Barthel Index. CONCLUSIONS: Perceived age was shown to be a reliable biomarker for cognitive assessment. Geriatr Gerontol Int 2020; 20: 779-784.


Assuntos
Cognição/fisiologia , Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Face/fisiologia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Feminino , Avaliação Geriátrica , Humanos , Modelos Logísticos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Tóquio
11.
J Alzheimers Dis ; 76(2): 481-489, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32651328

RESUMO

BACKGROUND: The COVID-19 pandemic is changing clinical practice in neurology, after the governments decided the introduction of social distancing and interruption of medical non-emergency services in many countries. Teleneurology is an effective tool for the remote evaluation of patients but its adoption for frontotemporal lobar dementia (FTD) is in a preliminary stage. OBJECTIVE: We evaluated multidisciplinary assessment of patients with FTD using telehealth during the COVID-19 pandemic. METHODS: All patients received a diagnosis of FTD during 2018-2019 according to international criteria. A structured questionnaire and Clinical Dementia Rating Scale (CDR)-FTD were used by the neurologist with patients and/or caregivers. Index symptoms of COVID-19 infection were searched. RESULTS: Twenty-eight clinical interviews were completed with caregivers and four with both patients/caregivers. Most patients and caregivers were satisfied with the neurological interview and expressed their willingness to continue to be included in remote evaluation programs (90%). Fifty percent of patients experienced significant worsening of clinical picture and quality of life since the start of social distancing. The CDR-FTD scale revealed a significant worsening of behavior (p = 0.01) and language functions (p = 0.009), compared to the last in-person evaluation at the center. One patient presented index symptoms of COVID-19 infection and was confirmed to be positive for COVID-19 with pharyngeal swab. CONCLUSION: The study was conducted in Italy, one of the countries hit particularly hard by the COVID-19 pandemic, with interruption of all non-emergency medical services. Our study indicates that telemedicine is a valid tool to triage patients with FTD to increase practice outreach and efficiency.


Assuntos
Infecções por Coronavirus , Assistência à Saúde/métodos , Degeneração Lobar Frontotemporal/diagnóstico , Pandemias , Pneumonia Viral , Telemedicina/métodos , Idoso , Idoso de 80 Anos ou mais , Comportamento , Progressão da Doença , Feminino , Degeneração Lobar Frontotemporal/psicologia , Humanos , Itália , Idioma , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Qualidade de Vida , Quarentena/psicologia , Inquéritos e Questionários , Triagem/métodos
12.
Medicine (Baltimore) ; 99(29): e21193, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702882

RESUMO

Delayed neurocognitive recovery (DNR) is common in elderly patients after major noncardiac surgery. This study was designed to investigate the best statistical rule in diagnosing DNR with the Montreal cognitive assessment (MoCA) in elderly surgical patients.This was a cohort study. One hundred seventy-five elderly (60 years or over) patients who were scheduled to undergo major noncardiac surgery were enrolled. A battery of neuropsychological tests and the MoCA were employed to test cognitive function at the day before and on fifth day after surgery. Fifty-three age- and education-matched nonsurgical control subjects completed cognitive assessment with the same instruments at the same time interval. The definition of the international study of postoperative cognitive dysfunction (ISPOCD 1) was adopted as the standard reference for diagnosing DNR. With the MoCA, the following rules were used to diagnose DNR: the cut-off point of ≤26; the 1 standard deviation decline from baseline; the 2 scores decline from baseline; and the Z score of ≥1.96. The sensitivity and specificity as well as the area under receiver operating characteristic curve for the above rules in diagnosis of DNR were calculated.The incidence of DNR was 13.1% (23/175) according to the ISPOCD1 definition. When compared with the standard reference, the 2 scores rule showed the best combination of sensitivity (82.6%, 95% confidence interval [CI] 67.1%-98.1%) and specificity (82.2%, 95% CI 76.2%-88.3%); it also had the largest area under receiver operating characteristic curve (0.824, 95% CI 0.728-0.921, P < .001). The cut-off point rule showed high sensitivity (95.7%) and low specificity (37.5%), whereas the 1 standard deviation and the Z score rules showed low sensitivity (47.8% and 21.7%, respectively) and high specificity (93.4% and 97.3%, respectively).Compared with the ISPOCD1 definition, the 2 scores rule with MoCA had the best combination of sensitivity and specificity to diagnose DNR.


Assuntos
Testes de Estado Mental e Demência/normas , Transtornos Neurocognitivos/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência/estatística & dados numéricos , Pessoa de Meia-Idade , Transtornos Neurocognitivos/classificação , Transtornos Neurocognitivos/fisiopatologia , Testes Neuropsicológicos , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
13.
PLoS One ; 15(7): e0234659, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614834

RESUMO

BACKGROUND: The relationship between poor oral health conditions and cognitive decline is unclear. OBJECTIVE: To examine the association between oral health and cognition in humans and rats. METHODS: In humans: a cross-sectional study was conducted. Cognitive levels were evaluated by the Mini Mental State Examination (MMSE); oral conditions were reflected by the number of missing index teeth, bleeding on probing, and probing pocket depth (PD). In rats: a ligature-induced (Lig) periodontitis model and Aß25-35-induced model of Alzheimer's disease (AD) were established; tumor necrosis factor-α (TNF-α), interleukin 1 (IL-1), interleukin 6 (IL-6), and C-reactive protein levels in the hippocampus and cerebral cortex were detected. RESULTS: MMSE scores for the number of missing index teeth ≥ 7 group were significantly lower than those in the ≤ 6 group. A negative relationship (correlation coefficient ρ = -0.310, P = 0.002) was observed between MMSE scores and number of missing index teeth. More missing index teeth and lower education levels were independent risk factors for cognitive decline. A negative relationship (correlation coefficient ρ = -0.214, P = 0.031) was observed between MMSE scores and average PD. TNF-α and IL-6 levels in the hippocampus of the Lig+AD group were significantly higher than those of the AD group. IL-1 and IL-6 levels in the cerebral cortex of the Lig+AD group were significantly higher than those of the AD group. CONCLUSION: Poor oral health conditions including more missing index teeth and higher average PD may be risk factors for cognitive decline. Periodontitis may increase inflammatory cytokines in rat models of AD.


Assuntos
Transtornos Cognitivos/etiologia , Saúde Bucal , Periodontite/complicações , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/etiologia , Peptídeos beta-Amiloides/toxicidade , Animais , Proteína C-Reativa/análise , Causalidade , Córtex Cerebral/química , China/epidemiologia , Transtornos Cognitivos/epidemiologia , Comorbidade , Estudos Transversais , Índice CPO , Modelos Animais de Doenças , Feminino , Hipocampo/química , Humanos , Interleucina-1/análise , Masculino , Aprendizagem em Labirinto , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Fragmentos de Peptídeos/toxicidade , Índice Periodontal , Periodontite/epidemiologia , Periodontite/etiologia , Periodontite/fisiopatologia , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fatores de Risco , Fator de Necrose Tumoral alfa/análise
14.
Gerontology ; 66(4): 401-408, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32623430

RESUMO

BACKGROUND: Many studies have demonstrated an inverse relationship between gait performance and cognitive impairment. The main purposes of this study were: (1) to design and validate a complex gait test (CGT) in older people, (2) to analyze the effects of age and sex on CGT, and (3) to analyze the association between CGT performance and physical functioning and cognitive measures. METHODS: A total of 279 older people (60-97 years) were analyzed in 2019. Fitness tests, gait performance, and several cognitive measures such asthe Trail-Walking Test and Montreal Cognitive Assessment were used. RESULTS: The CGT reported adequate reliability and validity parameters. In the test-retest analysis, the intra-class correlation coefficient was 0.868 (p < 0.001). There was a significant correlation between the CGT and Trail-Walking Test (r = 0.592; p < 0.001). The linear regression analysis showed that the CGT was associated with the Montreal Cognitive Assessment (R2 = 0.357; p =0.001). The binary logistic regression analysis revealed that a high CGT score was a risk factor for mild cognitive impairment (odds ratio 1.201, 95% CI 1.081-1.334; p = 0.001). The ROC curve of the mild cognitive impairment was predicted by the CGT performance (area under the curve = 0.768, 95% CI 0.647-0.889; p < 0.001), reaching the cut-off point at 20.25 s. CONCLUSIONS: The CGT showed good reliability and validity and may serve as a potential biomarker in mild cognitive impairment prediction in older adults aged 60-97 years.


Assuntos
Cognição/fisiologia , Teste de Esforço/normas , Marcha/fisiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/fisiopatologia , Estudos de Coortes , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fatores Sexuais , Espanha , Caminhada/fisiologia
15.
Cogn Behav Neurol ; 33(2): 129-136, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32496298

RESUMO

BACKGROUND: The Montreal Cognitive Assessment (MoCA) is often used for cognitive screening across health care settings, especially in rehabilitation centers, where assessment and treatment of cognitive function is considered key for successful multidisciplinary treatment. Although the original MoCA validation study suggested a cut score of <26 to identify cognitive impairment, recent studies have suggested that lower cut scores should be applied. OBJECTIVES: To examine the percentage of positive screens for cognitive impairment using the MoCA in a veteran postacute care (PAC) rehabilitation setting and to identify the most accurate MoCA cut score based on criterion neuropsychological measures. METHODS: We obtained data from 81 veterans with diverse medical diagnoses who had completed the MoCA during their admission to a PAC unit. A convenience subsample of 50 veterans had also completed four criterion neuropsychological measures. RESULTS: Depending on the cut score used, the percentage of individuals classified as impaired based on MoCA performance varied widely, ranging from 6.2% to 92.6%. When predicting performance using a more comprehensive battery of criterion neuropsychological tests, we identified <22 as the most accurate MoCA cut score to identify a clinically relevant level of impairment and <24 to identify milder cognitive impairment. CONCLUSIONS: Our findings suggest that a MoCA cut score of <26 carries a risk of misdiagnosis of cognitive impairment, and scores in the range of <22 to <24 are more reliable for identifying cognitive impairment.


Assuntos
Testes de Estado Mental e Demência/normas , Cuidados Semi-Intensivos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veteranos
16.
Mayo Clin Proc ; 95(6): 1281-1292, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32498781

RESUMO

Dementia affects nearly 50 million people worldwide, translating into one new case every 3 seconds. Dementia syndrome is one of the leading causes of disability among older adults, yet it remains vastly underdiagnosed. A timely diagnosis of dementia is essential to ensuring optimal care and support of individuals and their loved ones. Although there is no single test for dementia, health care providers can use a structured approach to the workup and management of new cognitive symptoms. Comprehensive MEDLINE and PubMed searches were performed to develop an unbiased, practical diagnostic approach to these symptoms. This review guides primary care providers in the workup, diagnosis, delivery, and initial management of patients presenting with new cognitive symptoms.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Atenção Primária à Saúde/métodos , Idoso , Disfunção Cognitiva/fisiopatologia , Demência/fisiopatologia , Humanos , Programas de Rastreamento/métodos , Testes de Estado Mental e Demência
17.
J Alzheimers Dis ; 76(1): 41-47, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32568211

RESUMO

BACKGROUND: Neuropsychiatric symptoms, such as depression, anxiety, apathy, agitation, and hallucinations, are frequent in Alzheimer's disease (AD) and their prevalence tends to increase with external stressors. OBJECTIVE: We offer the first investigation of the effects of confinement during the COVID-19 crisis on neuropsychiatric symptoms in patients with AD. METHODS: We contacted caregivers of 38 patients with AD who were confined to their homes for nearly two months and asked them to report whether patients experienced any change in neuropsychiatric symptoms during, compared to before, the confinement and rate its severity and impact on themselves using the Neuropsychiatric Inventory-Questionnaire. RESULTS: Among the 38 patients, only 10 demonstrated neuropsychiatric changes during the confinement. Cognitive function of these 10 patients, assessed with the Mini-Mental State Examination, was worse than that of patients who did not demonstrate neuropsychiatric changes. Interestingly, among the 10 patients with neuropsychiatric changes, the duration of confinement significantly correlated with the severity of symptoms as well as with their caregivers' distress. DISCUSSION: The confinement seems to impact neuropsychiatric symptomatology in AD patients with low baseline cognitive function.


Assuntos
Doença de Alzheimer/psicologia , Betacoronavirus , Infecções por Coronavirus/psicologia , Transtornos Mentais/psicologia , Pneumonia Viral/psicologia , Quarentena/psicologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Quarentena/tendências
18.
Neurology ; 95(9): e1126-e1133, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32571850

RESUMO

OBJECTIVE: To determine whether blood-based biomarkers can differentiate older veterans with and without traumatic brain injury (TBI) and cognitive impairment (CogI). METHODS: We enrolled 155 veterans from 2 veterans' retirement homes: 90 without TBI and 65 with TBI history. Participants were further separated into CogI groups: controls (no TBI, no CogI), n = 60; no TBI with CogI, n = 30; TBI without CogI, n = 30; and TBI with CogI, n = 35. TBI was determined by the Ohio State University TBI Identification Method. CogI was defined as impaired cognitive testing, dementia diagnosis, or use of dementia medication. Blood specimens were enriched for CNS-derived exosomes. Proteins (neurofilament light [NfL], total tau, glial fibrillary acidic protein [GFAP], α-synuclein, ß-amyloid 42 [Aß42], and phosphorylated tau [p-tau]) and cytokines (tumor necrosis factor-α [TNF-α], interleukin-6 [IL-6], and interleukin-10) were measured using ultrasensitive immunoassays. RESULTS: Veterans were, on average, 79 years old. In participants with TBI history, 65% had mild TBI; average time from most recent TBI was 37 years. In adjusted analyses, the TBI and CogI groups differed on CNS-enriched exosome concentration of p-tau, NfL, IL-6, TNF-α (all p < 0.05), and GFAP (p = 0.06), but not on Aß42 or other markers. Adjusted area under the curve (AUC) analyses found that all significantly associated biomarkers combined separated TBI with/without CogI (AUC, 0.85; 95% confidence interval [CI], 0.74-0.95) and CogI with/without TBI (AUC, 0.88; 95% CI, 0.77-0.99). CONCLUSIONS: Increased levels of blood-based, CNS-enriched exosomal biomarkers associated with TBI and CogI can be detected even decades after TBI. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in veterans with a history of TBI, CNS-enriched exosome concentration of p-tau, NfL, IL-6, and TNF-α are associated with CogI.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Disfunção Cognitiva/sangue , Interleucina-6/sangue , Proteínas de Neurofilamentos/sangue , Fator de Necrose Tumoral alfa/sangue , Veteranos , Proteínas tau/sangue , Idoso , Idoso de 80 Anos ou mais , Peptídeos beta-Amiloides/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Exossomos/metabolismo , Feminino , Proteína Glial Fibrilar Ácida/sangue , Humanos , Interleucina-10/sangue , Masculino , Testes de Estado Mental e Demência , Molécula L1 de Adesão de Célula Nervosa/metabolismo , Testes Neuropsicológicos , Fragmentos de Peptídeos/sangue , Fosforilação , alfa-Sinucleína/sangue
19.
Neurology ; 95(9): e1188-e1198, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32586899

RESUMO

OBJECTIVE: To assess the relationship among iron accumulation, blood-brain barrier (BBB) damage, and cognitive function in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). METHODS: We enrolled 21 patients with NOTCH3 mutations and 21 age-matched healthy controls in this cross-sectional study. All participants underwent global physical and cognitive assessments and brain MRI using voxel-based quantitative susceptibility mapping (QSM; iron deposition measure) and dynamic contrast-enhanced MRI (BBB permeability measure). We compared behavioral and imaging data between the groups and analyzed the correlations in each group. RESULTS: Among 21 NOTCH3 mutation carriers, 10 were symptomatic and 11 asymptomatic. Montreal Cognitive Assessment scores were significantly different among the groups (symptomatic < asymptomatic < control participants). Voxel-based QSM analysis revealed that the symptomatic group had higher QSM values than did the asymptomatic group in the putamen, caudate nucleus, temporal pole, and centrum semiovale. These QSM values were positively correlated with regional BBB permeabilities (putamen: r = 0.57, p = 0.006; caudate nucleus: r = 0.51, p = 0.019; temporal pole: r = 0.48, p = 0.030; centrum semiovale: r = 0.45, p = 0.044) and negatively correlated with Montreal Cognitive Assessment scores (caudate nucleus: r = -0.53, p = 0.012; temporal pole: r = -0.56, p = 0.008). CONCLUSIONS: This study showed that cerebral iron burden was associated with regional BBB permeability and cognitive dysfunction in patients with CADASIL, highlighting the potential of these imaging techniques as auxiliary biomarkers to monitor the course of small vessel disease.


Assuntos
Barreira Hematoencefálica/metabolismo , Encéfalo/metabolismo , CADASIL/metabolismo , Cognição , Ferro/metabolismo , Adulto , Idoso , Doenças Assintomáticas , Encéfalo/diagnóstico por imagem , CADASIL/diagnóstico por imagem , CADASIL/genética , CADASIL/psicologia , Estudos de Casos e Controles , Núcleo Caudado/diagnóstico por imagem , Núcleo Caudado/metabolismo , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/metabolismo , Feminino , Globo Pálido/diagnóstico por imagem , Globo Pálido/metabolismo , Humanos , Imagem por Ressonância Magnética , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Mutação , Testes Neuropsicológicos , Permeabilidade , Putamen/diagnóstico por imagem , Putamen/metabolismo , Receptor Notch3/genética , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/metabolismo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA