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1.
Public Health Rep ; 136(1): 97-106, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33211985

RESUMO

OBJECTIVES: An understanding of mental health symptoms during the coronavirus disease 2019 (COVID-19) pandemic is critical to ensure that health policies adequately address the mental health needs of people in the United States. The objective of this study was to examine mental health symptoms among US adults in an early stage of the COVID-19 pandemic. METHODS: We conducted a cross-sectional study in late March 2020 with a national sample of 963 US adults using an online research platform. Participants self-reported state of residence, psychosocial characteristics, and levels of anxiety, depression, anger, cognitive function, and fatigue in the context of COVID-19 using validated patient-reported outcomes scales in the Patient-Reported Outcome Measurement Information System measures. We used analysis of variance and multivariate linear regression to evaluate correlates of mental health symptoms. RESULTS: Overall, participants reported high levels of anxiety (mean [SD], 57.2 [9.3]) and depression (mean [SD], 54.2 [9.5]). Levels of anger, anxiety, cognitive function, depression, and fatigue were significantly higher among the Millennial Generation and Generation X (vs Baby Boomers), those with not enough or enough (vs more than enough) financial resources, females vs males), those with self-reported disability (vs no self-reported disability), and those with inadequate (vs adequate) health literacy. In adjusted models, being in Generation X and the Millennial Generation (vs Baby Boomer), having not enough or enough vs more than enough) financial resources, and having inadequate (vs adequate) health literacy were most strongly correlated with worse mental health symptoms. CONCLUSIONS: Results suggest that mental health symptoms during the early stages of the COVID-19 pandemic were prevalent nationally, regardless of state of residence and especially among young, psychosocially vulnerable groups.


Assuntos
/epidemiologia , Saúde Mental/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Ansiedade/epidemiologia , Transtornos Cognitivos/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Fadiga/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Fatores Sexuais , Fatores Socioeconômicos , Estresse Psicológico/epidemiologia , Estados Unidos/epidemiologia
2.
Alzheimers Res Ther ; 12(1): 170, 2020 12 30.
Artigo em Inglês | MEDLINE | ID: mdl-33380345

RESUMO

COVID-19 is primarily a respiratory disease but up to two thirds of hospitalised patients show evidence of central nervous system (CNS) damage, predominantly ischaemic, in some cases haemorrhagic and occasionally encephalitic. It is unclear how much of the ischaemic damage is mediated by direct or inflammatory effects of virus on the CNS vasculature and how much is secondary to extracranial cardiorespiratory disease. Limited data suggest that the causative SARS-CoV-2 virus may enter the CNS via the nasal mucosa and olfactory fibres, or by haematogenous spread, and is capable of infecting endothelial cells, pericytes and probably neurons. Extracranially, SARS-CoV-2 targets endothelial cells and pericytes, causing endothelial cell dysfunction, vascular leakage and immune activation, sometimes leading to disseminated intravascular coagulation. It remains to be confirmed whether endothelial cells and pericytes in the cerebral vasculature are similarly targeted. Several aspects of COVID-19 are likely to impact on cognition. Cerebral white matter is particularly vulnerable to ischaemic damage in COVID-19 and is also critically important for cognitive function. There is accumulating evidence that cerebral hypoperfusion accelerates amyloid-ß (Aß) accumulation and is linked to tau and TDP-43 pathology, and by inducing phosphorylation of α-synuclein at serine-129, ischaemia may also increase the risk of development of Lewy body disease. Current therapies for COVID-19 are understandably focused on supporting respiratory function, preventing thrombosis and reducing immune activation. Since angiotensin-converting enzyme (ACE)-2 is a receptor for SARS-CoV-2, and ACE inhibitors and angiotensin receptor blockers are predicted to increase ACE-2 expression, it was initially feared that their use might exacerbate COVID-19. Recent meta-analyses have instead suggested that these medications are protective. This is perhaps because SARS-CoV-2 entry may deplete ACE-2, tipping the balance towards angiotensin II-ACE-1-mediated classical RAS activation: exacerbating hypoperfusion and promoting inflammation. It may be relevant that APOE ε4 individuals, who seem to be at increased risk of COVID-19, also have lowest ACE-2 activity. COVID-19 is likely to leave an unexpected legacy of long-term neurological complications in a significant number of survivors. Cognitive follow-up of COVID-19 patients will be important, especially in patients who develop cerebrovascular and neurological complications during the acute illness.


Assuntos
Encefalopatias/epidemiologia , Encefalopatias/virologia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/virologia , Humanos
3.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(10. Vyp. 2): 39-45, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33205929

RESUMO

Cognitive impairment or delirium occurs in about 40% of elderly patients after surgery. The increasing number of elderly people has led to a significant increase in the number of cases of postoperative cognitive dysfunction (POCD). This is one of the most important medical and social problems, the analysis of which is especially difficult, since it requires the coordination of a large number of specialties: anesthesiology, surgery, neurology, psychiatry, neuropsychology, as well as fundamental neurosciences. Thus, a systematic multidisciplinary approach that takes into account all possible factors affecting the condition of patients should be considered. The article is devoted to the main aspects of the pathogenesis, prevention and treatment of POCD.


Assuntos
Transtornos Cognitivos , Disfunção Cognitiva , Delírio , Idoso , Cognição , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Humanos , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório
4.
Afr Health Sci ; 20(2): 487-596, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33163015

RESUMO

Background: It is estimated that almost half of all people living with HIV have some form of neurocognitive impairment, but few studies have looked at the risk of neurocognitive impairment and its associated factors in Ghana, due in part to limited resources for such testing. Objectives: To examine neurocognitive performance in a group of Ghanaians living with HIV and possible factors that contribute to their performance. Methods: One hundred and four patients were assessed using a selection of brief non-invasive neuropsychological assessments as well as the International HIV Dementia Scale. Psycho-behavioural factors (alcohol use, depression, and medication adherence) as well as demographic characteristics and functional daily activities were assessed to determine their association with neurocognitive performance, using linear regression and receiver operating characteristic analyses. Result: About 48% of the participants met the criteria for risk of neurocognitive impairment. Age, education, and symptoms of depression were found to be significantly associated with the risk of impairment. Conclusion: Some people living with HIV showed risk of neurocognitive impairment, which was significantly associated with education, age and depressive symptoms. It is therefore important to consider routine neurocognitive screening in HIV management to recognize any risks for early interventions.


Assuntos
Complexo AIDS Demência/epidemiologia , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Transtornos Cognitivos/epidemiologia , Depressão/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Complexo AIDS Demência/psicologia , Adulto , Fatores Etários , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Transtornos Cognitivos/etiologia , Estudos Transversais , Depressão/etiologia , Escolaridade , Feminino , Gana/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos , Prevalência , Desempenho Psicomotor , Índice de Gravidade de Doença , Fatores Socioeconômicos
5.
PLoS One ; 15(11): e0241599, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33137145

RESUMO

INTRODUCTION: Electronic cigarette use (vaping) has become popular in recent years. The number of Americans with a variety of cognitive deficits has been increasing dramatically. This study aimed to examine the potential association of vaping with subjective cognitive complaints in US adults. METHODS: A combined 2016 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) national survey dataset yielded 886,603 adults who indicated their smoking and vaping status, as well as whether they had subjective cognitive complaints. With this dataset, the cross-sectional association of electronic cigarette use with subjective cognitive complaints was examined using multivariable weighted logistic regression models. RESULTS: Both dual users (adjusted Odds Ratio [aOR] = 2.07; 95% Confidence Interval [CI] = 1.66 to 2.60) and current vapers who were either ex-smokers (aOR = 1.94; 95% CI = 1.40 to 2.71) or never smoked (aOR = 1.96; 95% CI = 1.16 to 3.30) showed a significantly higher association with subjective cognitive complaints than never users. Current smokers (aOR = 1.49; 95% CI = 1.32 to 1.69) and ex-smokers (aOR = 1.25; 95% CI = 1.11 to 1.41) had a significantly higher association with subjective cognitive complaints compared to never users. Compared to current smokers, the ex-smokers showed a lower association with subjective cognitive complaints (aOR = 0.84; 95% CI = 0.73 to 0.96). Finally, the association of vaping with subjective cognitive complaints was not statistically significant in individual age group. CONCLUSION: Similar to smoking, vaping is associated with subjective cognitive complaints in US adults. These results provide preliminary evidence for a cross-sectional association of vaping with potential cognitive health effects in adults.


Assuntos
Transtornos Cognitivos/epidemiologia , Cognição , Vaping/epidemiologia , Adolescente , Adulto , Idoso , Transtornos Cognitivos/diagnóstico , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Isr Med Assoc J ; 22(10): 633-638, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33070488

RESUMO

BACKGROUND: In Israel, critically ill patients are ventilated and managed in intensive care units or general wards. OBJECTIVES: To compare the mortality rates and long-term cognitive and functional outcomes of ventilated patients who underwent tracheostomy insertion in the Medical ICU (MICU) versus those cared for in the in-patient wards. METHODS: The study comprised 170 patients who underwent percutaneous dilatational tracheostomy (PDT) over an 18-month period in the MICU (n=102) and in in-patient wards (internal medicine and neurology) (n=68). Telephone interviews were conducted with living patients and/or their relatives at least 6 months after discharge from the hospital. RESULTS: Ward patients were 10 years older than ICU patients undergoing PDT (P = 0.003). The length of stay (LOS) in the wards was longer than in the ICU (P < 0.001), whereas the total LOS in the hospital was similar (P = 0.43). ICU mortality was lower than in the wards (P = 0.001) but hospital mortality was comparable between the two groups (P = 0.17). At 6 months follow-up more ICU patients were fully conscious, weaned from ventilation, and decannulated. More patients in the ICU group were at home and were independent or had mildly impaired activities of daily living. More patients in the ward group were residing in long-term care facilities with functional limitations. CONCLUSIONS: MICU patients who undergo tracheostomy may have a good long-term functional and cognitive outcome. More studies are needed to further assess long-term outcomes in these patients.


Assuntos
Mortalidade Hospitalar/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Quartos de Pacientes/estatística & dados numéricos , Respiração Artificial/métodos , Traqueostomia/métodos , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Fatores Etários , Causas de Morte , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/fisiopatologia , Estudos de Coortes , Cuidados Críticos/métodos , Estado Terminal/terapia , Feminino , Humanos , Israel , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Respiração Artificial/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Estatísticas não Paramétricas , Traqueostomia/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
7.
Anesth Analg ; 131(5): 1582-1588, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079882

RESUMO

BACKGROUND: Frailty is a reduced capacity to recover from a physiologically stressful event. It is well established that preoperative frailty is associated with poor postoperative outcomes, but it is unclear if this includes cognitive decline following anesthesia and surgery. This retrospective observational study was a secondary analysis of data from a previous study (the Anaesthesia, Cognition, Evaluation [ACE] study). We aimed to identify if preoperative frailty or prefrailty is associated with preoperative and postoperative neurocognitive disorders or postoperative cognitive dysfunction. METHODS: The ACE study enrolled 300 participants aged ≥60 scheduled for elective total hip joint replacement and who underwent a full neuropsychological assessment at baseline and 3 and 12 months postoperatively. We applied patient data to 2 frailty models; both were based on an accumulation of deficits score: the reported Edmonton frail scale (REFS) and the comprehensive geriatric assessment-frailty index (CGA-FI) based on the comprehensive geriatric assessment. We calculated these 2 scores using baseline data collected from the medical history, demographic and clinical data as well as self-reported questionnaires. Some items on the REFS (3 of 18 or 17%) and the CGA-FI (37 of 51 or 27%) did not have an equivalent item in the ACE data. RESULTS: The mean age (standard deviation [SD]) was 70.1 years (6.6) with more women (197 [66%]). Using the REFS model, 40 of 300 (13.3%) patients were classified as vulnerable, mild, or moderately frail. Using the CGA-FI model, 69 of 300 (23%) were classified as intermediate or high frailty. The REFS and the CGA-FI were strongly correlated (r = 0.75; P < .01) with 34 of 300 (11%) meeting criteria for frailty by both the REFS and the CGA-FI.Frailty or prefrailty was associated with cognitive decline at 3 and 12 months using the REFS (odds ratio [OR], 1.51, 95% confidence interval [CI], 1.02-2.23 and OR, 2.00, 95% CI, 1.26-3.17, respectively) after adjusting for baseline mini-mental state examination (MMSE), smoking, hypertension, diabetes, history of acute myocardial infarction (AMI), and estimated intelligence quotient (IQ). Age did not modify this association. After adjusting for multiple comparisons, 3-month cognitive decline was no longer significantly associated with baseline frailty. CONCLUSIONS: This retrospective analysis demonstrates an association between baseline frailty and postoperative neurocognitive disorders, particularly using the more extensive REFS scoring method. This supports preoperative screening for frailty to risk-stratify patients, and identify and implement preventive strategies and to improve postoperative outcomes for older individuals.


Assuntos
Artroplastia de Quadril/efeitos adversos , Transtornos Cognitivos/etiologia , Fragilidade , Complicações Pós-Operatórias/psicologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/psicologia , Transtornos Cognitivos/epidemiologia , Feminino , Idoso Fragilizado , Avaliação Geriátrica , Humanos , Masculino , Testes de Estado Mental e Demência , Testes Neuropsicológicos , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Autorrelato , Fatores Sexuais , Inquéritos e Questionários
8.
Rev Esp Geriatr Gerontol ; 55(6): 317-325, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32736821

RESUMO

OBJECTIVE: The SARS-CoV-2 pandemic conditions high mortality rates in hospitalized elderly. Currently, a few studies include octogenarian patients and none of them analyze the impact of functional status on this health outcome. Our objective is to describe the characteristics of patients older than 80 years hospitalized for coronavirus disease 2019 (COVID-19), to determine the mortality rate and to identify associated factors. MATERIAL AND METHODS: Prospective observational study carried out on patients over 80 years admitted for COVID-19 in a Geriatrics Service. Sociodemographic, clinical, functional, mental, analytical, radiological, therapeutic and healthcare variables were collected. The factors associated with in-hospital lethality were analyzed by bivariate analysis. RESULTS: 58 cases with laboratory-confirmed COVID-19 were included, mean age 88.3 ± 5.4 years, 69% women, 65.5% moderate-severe cognitive impairment and previous Barthel index 40.66 ± 36. The main symptoms were fever (60,3%), dyspnea (53.4%) and deterioration of functional condition (50%). The most frequent comorbidities were cardiovascular disease (75.9%), hypertension (HT) (74.1%) and chronic kidney disease (CKD) (50%). A mortality rate of 41,4% was detected and the associated factors were: severe functional dependence (OR = 3.8 [1.2-12.2]), moderate-severe cognitive impairment (OR = 4.9 [1-25.4]) and CKD (OR = 3.2 [1.1-9.7]). CONCLUSION: High mortality rates are observed in older patients hospitalized for COVID-19, with a higher risk of dying in those with severe functional dependence or cognitive impairment. These findings reinforce the value of Geriatric Assessment to develop strategies to adapt diagnostic and therapeutic decision-making and to optimize care for elderly patients in the event of a new epidemic outbreak.


Assuntos
/mortalidade , Mortalidade Hospitalar , Idoso de 80 Anos ou mais , /epidemiologia , Doenças Cardiovasculares/epidemiologia , Transtornos Cognitivos/epidemiologia , Dispneia/etiologia , Feminino , Febre/etiologia , Humanos , Hipertensão/epidemiologia , Masculino , Pandemias , Estudos Prospectivos , Insuficiência Renal Crônica/epidemiologia , Espanha/epidemiologia , Avaliação de Sintomas
9.
BMC Neurol ; 20(1): 280, 2020 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-32664858

RESUMO

BACKGROUND: Human Immunodeficiency Virus (HIV) infection causes a myriad of neurological complications including cognitive deficits referred to as HIV-Associated Neurocognitive Disorders (HAND). With the introduction of combination antiretroviral therapy, there has been an epidemiological shift in cognitive disorders with a decline in the more severe HIV-Associated Dementia (HAD) to an increase in the less severe HAND: Asymptomatic Neurocognitive Impairment (ANI) and HIV-associated Mild Neurocognitive Disorder (MND). Central Nervous System (CNS) involvement in HIV interferes with cognitively demanding activities of daily living and hence a worse quality of life. Early diagnosis is delayed until symptoms are overt. METHODS: We conducted a cross sectional analytical study of HIV infected persons on antiretroviral therapy attending HIV clinic. A systematic random sampling was done to select 360 patients. An interviewer administered structured questionnaire was used to collect socio-demographic data while the CD4 count and viral load were retrieved from the Academic Model Providing Access to Healthcare (AMPATH) database. Pearson's Chi Square test was used to compare proportions while independent sample t- test was used to compare continuous variables between the patients diagnosed with HAND and those without HAND. Logistic regression model was used to assess the factors associated with HAND. RESULTS: The mean age of the study participants was 40.2 years. The overall prevalence of HAND was (81.1%) N = 292. Mild HAND (ANI and MND) was present (78.6%) N = 283, Severe HAND (HAD) (2.5%) N = 9. The factors associated with HAND were older age OR: 1.06 (95% CI: 1.03, 1.10), male gender OR: 0.48 (95% CI: 0.24, 0.97), Advanced WHO clinical staging OR: 2.45 (95% CI: 1.20, 5.01) and a higher level of education; secondary/tertiary OR: 0.16 (95% CI: 0.07, 0.38); 0.11 (95% CI: 0.04, 0.35). CONCLUSION: The prevalence of HAND in this study population was found to be high (81.1%). Older age and advanced WHO clinical staging were associated with an increased risk of hand while higher level of education and male gender were protective.


Assuntos
Transtornos Cognitivos , Infecções por HIV , Complexo AIDS Demência , Adulto , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/virologia , Estudos Transversais , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Quênia/epidemiologia , Prevalência
10.
Rev Esp Salud Publica ; 942020 Jul 02.
Artigo em Espanhol | MEDLINE | ID: mdl-32613950

RESUMO

OBJECTIVE: In Spain, the resources of the System for Autonomy and Attention to Dependency (SAAD) for the elderly are directed to intervene on dependency situations. They focus attention exclusively on physical and cognitive effects while the evidence and the main national and international entities indicate the need to establish measures to promote autonomy and prevent dependence. METHODS: Descriptive observational study, conducted on a sample of n=279 people benefiting from the Economic Benefit for Care in the Family Environment (PECEF) in Palma de Mallorca: n=178 people between 55 and 85 years (<75, n=69.06; ≥75, n=108.97) in a situation of dependency and 101 caregivers. The objective of the study was to define the socio-demographic, health, social support and dependency variables, as well as those related to the caregiver-dependent interaction to define the profile of people with dependence and to identify if the Spanish Dependency Assessment Scale defines the Degrees of Dependency objectively according to the variables that affect it. RESULTS: The "Group with high dependency" contained 57 beneficiaries (32.84% sample). With low disposition of affective support and high of material support, it showed a low assessment of his state of health. The "Medium dependency group" defined 86 beneficiaries (49.71% sample). It was characterized by achieving medium / medium-high scores on variables which indicate the need for improvements in certain health areas. The "Low Dependency Group" defined 30 beneficiaries (17.34% sample). It obtained low levels in the scores of social support and perception of health. CONCLUSIONS: From the cluster analysis performed using SPSS 25.0, 3 groups were defined; a group with high dependence, one with medium dependence and one with low dependence. Certain social and family factors show a statistically significant influence (p≤≠0.05) on dependency situations that mark possible intervention proposals.


Assuntos
Cuidadores , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Análise por Conglomerados , Transtornos Cognitivos/epidemiologia , Pessoas com Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Classe Social , Espanha/epidemiologia
11.
J Stroke Cerebrovasc Dis ; 29(8): 104923, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689613

RESUMO

OBJECTIVE: In this prospective study, we aimed to investigate the presence and evolution of cerebellar cognitive affective syndrome in a cohort of isolated cerebellar stroke with no known cognitive or psychiatric impairment. We tried to distinguish the unconfounded effect of cerebellar lesions on neuropsychological processing. METHODS: After a meticulous exclusion procedure based on possible confounders, we recruited 14 patients and 13 age-matched healthy controls to the study, prospectively. All of the patients had a detailed initial neuropsychological assessment at the first week and a follow-up assessment at the 4th month after stroke. RESULTS: The prevalence of cognitive or behavioral-affective abnormalities in our cohort were 86% and 64% respectively. The patients exhibited mild and transient affective-behavioral abnormalities except for depressive symptoms that persisted in the subacute stage. They scored lower in general cognitive performance as revealed by mini mental test (p=0.001). Memory, executive functions, attention and working memory, central processing speed, and linguistic abilities were impaired (p<0.001; p=0.001; p=0.007; p=0.05; p<0.001 respectively). Improvement was evident only in memory domain of the cognitive functions in the subacute stage. Cognitive impairment was more likely with a medial or posterolateral infarct (p=0.014). Behavioral-affective abnormalities were not associated with a specific location in our cohort. Age seemed to negatively correlate with the recovery in general cognitive performance on the follow-up. CONCLUSIONS: These findings show that acute denervation of cerebellocortical projections leads to mild affective-behavioral abnormalities, and full-blown cerebellar cognitive affective syndrome is rare. However, cognition was significantly affected after an acute cerebellar infarct even in a previously healthy, non-demented pure population.


Assuntos
Afeto , Infartos do Tronco Encefálico/psicologia , Doenças Cerebelares/psicologia , Cerebelo/irrigação sanguínea , Transtornos Cognitivos/psicologia , Cognição , Transtornos do Humor/fisiopatologia , Doença Aguda , Atenção , Infartos do Tronco Encefálico/diagnóstico , Infartos do Tronco Encefálico/epidemiologia , Infartos do Tronco Encefálico/fisiopatologia , Estudos de Casos e Controles , Doenças Cerebelares/diagnóstico , Doenças Cerebelares/epidemiologia , Doenças Cerebelares/fisiopatologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/fisiopatologia , Função Executiva , Feminino , Humanos , Idioma , Masculino , Memória , Pessoa de Meia-Idade , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Turquia/epidemiologia
12.
Maturitas ; 138: 51-57, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32631588

RESUMO

BACKGROUND: Motoric Cognitive Risk syndrome (MCR), which combines Subjective Cognitive Complaint (SCC) and slow gait speed in individuals free of dementia and gait disability, is associated with cardiovascular risk factors and diseases as well as incident cognitive impairment. Little information on MCR exists in the Canadian population. This study aims to examine these associations in community-dwelling elderly people living in Quebec, which is a Canadian province. METHODS: Data was collected from the"Nutrition as a determinant of successful aging: The Quebec longitudinal study" (NuAge), which is a Quebec population-based observational cohort study with 3 years of follow-up. A subset of 1113 participants (age 73.8 ±â€¯4.1 and 51.9% female; 63.5% of the initial NuAge sample) was selected. MCR, cardiovascular risk factors and disease were recorded at baseline. Incident cognitive impairment was considered if the Modified Mini-Mental State Examination (3MS) score was ≤79/100 at subsequent annual visits. RESULTS: The prevalence of MCR was 4.2% at baseline and was significantly associated with diabetes (P < 0.032), cerebrovascular disease (P < 0.043) and incident cognitive impairment (P ≤ 0.001). The overall incidence of cognitive impairment during the 3-year follow-up period was 4.6%. A greater decrease of the 3MS score was observed in participants with MCR compared to those without MCR, at each annual assessment (P ≤ 0.001). CONCLUSION: MCR was associated with diabetes and cerebrovascular diseases at baseline, and incident cognitive impairment in NuAge study participants.


Assuntos
Doenças Cardiovasculares/epidemiologia , Transtornos Cognitivos/epidemiologia , Diabetes Mellitus/epidemiologia , Idoso , Transtornos Cognitivos/diagnóstico , Feminino , Humanos , Incidência , Vida Independente , Masculino , Testes Neuropsicológicos , Prevalência , Quebeque/epidemiologia , Fatores de Risco , Síndrome , Velocidade de Caminhada
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.
Lancet HIV ; 7(7): e504-e513, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32621876

RESUMO

High rates of cognitive disorders in antiretroviral-treated people living with HIV have been described worldwide. The exact prevalence of such cognitive disorders is determined by the definitions used, and the presence of these cognitive disorders significantly impacts the overall wellbeing of people with HIV. With the cohort of people with HIV becoming increasingly older, and having high rates of comorbidities and concomitant medication use, rates of cognitive disorders are likely to increase. Conversely, interventions are being sought to reduce the size of the latent HIV reservoir. If successful, such interventions are likely to also reduce the HIV reservoir in the brain compartment, which could result in improvements in cognitive function and reduced rates of impairment.


Assuntos
Antirretrovirais/uso terapêutico , Transtornos Cognitivos/epidemiologia , Infecções por HIV/complicações , Encéfalo/virologia , Cognição , Transtornos Cognitivos/complicações , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/prevenção & controle , Estudos de Coortes , Comorbidade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Prevalência , Latência Viral
15.
Internist (Berl) ; 61(9): 929-938, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32666209

RESUMO

Approximately 40% of patients with heart failure show cognitive deficits, such as concentration difficulties, attention deficits, and memory impairment. Affected patients have a higher rate of rehospitalization and an increased mortality. This could be due to low adherence mediated by a lack of disease-specific knowledge and strategies to deal with symptom exacerbation. The pathogenesis of cognitive deficits in heart failure is multifactorial. In this respect the heart failure itself as well as cardiovascular risk factors and comorbidities play a role. Orientating neuropsychological screening tests can show a first indication of the presence of cognitive impairment. When identified, the causes can be specifically treated and care can be optimized through certain measures, such as the involvement of caregivers and healthcare providers.


Assuntos
Transtornos Cognitivos/etiologia , Disfunção Cognitiva/etiologia , Insuficiência Cardíaca/complicações , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/psicologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Comorbidade , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/psicologia , Humanos , Adesão à Medicação , Testes Neuropsicológicos
17.
Psychiatry Res ; 290: 113051, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32474065

RESUMO

Differences in cognitive function have been suggested in people with late-life depression between those with early- (EOD) and late-onset (LOD), possibly reflecting different etiologies. The cutoff point for EOD and LOD was the first depressive episode before age 60 or later. However, depressive symptoms at the time of disorder are important confounders. The study aimed to compare cognitive function in older people with EOD and LOD in the euthymic state. A sample of 135 participants aged 60+ with a history of major depressive disorder in remission, received neuropsychological evaluation including tests of memory, attention, processing speed, visuospatial function, language, and executive function. Individual test scores and a derived composite score were investigated as dependent variables against age of onset using multiple linear regressions adjusted for potential confounders, including residual depressive symptoms. We found EOD (N = 67) and LOD (N = 68) groups did not differ significantly in overall composite cognitive scores after adjustment. Of individual test scores, only those for immediate recall were significantly lower in participants with EOD compared to LOD. In conclusion, the study found no associations between cognitive function and age of onset in this sample of people with depressive disorder in remission. Active or residual depressive symptoms might have confounded this relationship in previous research.


Assuntos
Cognição/fisiologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Testes Neuropsicológicos , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/psicologia , Transtorno Depressivo Maior/epidemiologia , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão
18.
Rev Neurol (Paris) ; 176(6): 448-455, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32414533

RESUMO

In contrast to short-term cognitive outcomes, long-term cognitive outcomes (over 5 years) has been scarcely assessed so far. Yet, predicting long-term outcomes at any time point of the epilepsy, from initial diagnosis, to medically intractability is very important for therapeutic decision-making, patient information, and orientation. Assessing long-term cognitive outcomes in patients with epilepsy would ideally require longitudinal studies and a comparison with a healthy controls group. This issue has been addressed extensively, but with controversial results. However, there is a general consensus about the fact that cognitive outcome is not the same in all groups of patients with epilepsy. Possible prognostic factors include age at onset, duration of epilepsy, syndrome and etiology, seizure outcome and therapeutics. The multiplicity of factors makes it very difficult to assess their relative weight in individuals. Although long-term cognitive outcome studies are scarce, this issue has been specifically studied in newly diagnosed epilepsies and in focal drug-resistant epilepsies. In the first clinical setting, i.e. newly diagnosed epilepsy, it appears that cognitive deficits are already present at epilepsy onset in a significant proportion of patients but seem to remain stable over time. In focal drug-resistant epilepsies, cognitive deficits (mainly verbal memory) were generally shown to remain stable provided that seizures were controlled either by medication or by surgery. Beyond the possible correlation between seizure and cognitive outcome, no causal link however has been demonstrated between these two important outcomes.


Assuntos
Cognição/fisiologia , Epilepsia/tratamento farmacológico , Epilepsia/psicologia , Cognição/efeitos dos fármacos , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Humanos , Assistência de Longa Duração/psicologia , Prognóstico , Fatores de Tempo , Resultado do Tratamento
19.
Rev Neurol (Paris) ; 176(6): 468-479, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32418700

RESUMO

INTRODUCTION: The neuropsychology of epilepsy has been a major area of study for almost a century and cognitive impairments are an integral part of the new definition of epilepsy. Among such impairments, social cognition (SC) dysfunctions are of relatively recent interest. SC abilities refer to the body of knowledge and processes involved in establishing satisfying and appropriate social interactions. In particular, they allow the recognition of emotions in others, emotional experiences which are suitably adapted to social situations, and the ability to infer mental states in oneself and others. METHODS: An overeview was conducted of the available data within the literature, with the objective of presenting the SC disorders associated with certain types of epilepsy and the possible risk factors already explored i.e., localisation of epileptic focus, age of onset/duration of the disease, and effects of treatments including surgery. Studies investigating the potential repercussions of these disorders on patients' daily life have also been included. RESULTS: Social cognition disorders are an integral part of the cognitive disorders traditionally described in epilepsy. Indeed, a growing number of studies highlight the increased prevalence of SC disorders in various domains, and some patients appear to be more at risk than others. These disorders could be a major determining factor in the deterioration of patients' quality of life (QOL), particularly patients' support and social integration. This highlights the importance of assessing and managing these disorders in patients with epilepsy (PWE). Perspectives in the field of research and clinical practice are also evoked, such as exploring the links between disruptions in SC abilities and treatments, or developing specific tools for assessment and rehabilitation within the context of epilepsy.


Assuntos
Epilepsia/psicologia , Cognição/fisiologia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Emoções/fisiologia , Epilepsia/complicações , Epilepsia/epidemiologia , Humanos , Testes Neuropsicológicos , Reconhecimento Psicológico/fisiologia , Comportamento Social
20.
BMC Womens Health ; 20(1): 109, 2020 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434503

RESUMO

BACKGROUND: Immunological biomarkers were related to quality of life and neuropsychological performance in women recently diagnosed with breast cancer through the first six months of treatment. A comparison group of breast cancer survivors in remission were also evaluated. METHOD: Twenty women newly diagnosed with breast cancer and 26 breast cancer survivors at least a year after treatment were evaluated four times over a course of six to 8 months. The assessments included quality-of-life, emotional and spiritual well-being, sleep quality, computerized neuropsychological performance, and cytokine immunology biomarkers using flow cytometry. The principal immunological markers examined were the CD4+, CD8+, and CD16+ counts. RESULTS: Although equivalent at enrollment, active treatment women reported higher anxiety, depression, poorer quality-of-life, and poorer processing speed and accuracy on memory, logical processes, and coding neuropsychological tasks. They also had significantly higher CD8+ and CD16+ cell count levels during treatment over the next six to eight months than comparison group women in remission. Women undergoing chemotherapy as well during treatment phase also had a significant decline in CD4+ counts. Higher percent CD8+ levels during treatment was associated with poorer quality of life and more depression, while higher CD4+ and CD8+ were associated with poorer neuropsychological memory and processing speed performance. CONCLUSION: Significant increases in CD8+ is a sensitive biomarker of a broad range of poorer quality-of-life and neurocognitive functioning outcomes during breast cancer treatment, especially in women undergoing chemotherapy. Quality of life should be monitored in breast cancer patients and psychosocial support made available as a standard of care.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/imunologia , Transtornos Cognitivos/epidemiologia , Citocinas/sangue , Qualidade de Vida/psicologia , Adulto , Biomarcadores/sangue , Neoplasias da Mama/complicações , Neoplasias da Mama/psicologia , Feminino , Citometria de Fluxo , Humanos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Resultado do Tratamento
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