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1.
World Neurosurg ; 133: e89-e96, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31479795

RESUMO

OBJECTIVE: To evaluate the feasibility to treat complex internal carotid aneurysms by superficial temporal artery trunk-radial artery-middle cerebral artery (STAT-RA-MCA) bypass combined with balloon occlusion of internal carotid artery. METHODS: Postoperative clinical symptoms, the patency of bridge vessels (radial artery graft [RAG]), STAT and RAG diameters, RAG flow, cerebral blood flow (CBF), and mean transit time (MTT) were observed in 14 cases. Their correlations were analyzed. RESULTS: Except 1 case, RAG was patent in 13 cases. Glasgow Outcome Scale score was 4 in one case and 5 in 13 cases. In the 13 cases with postoperative RAG patency, the mean diameter of STAT increased from 2.1 mm before operation to 3.0 mm on the first day after operation; the mean diameter of RAG was 3.7 mm on the first day after operation. In 3 of the 13 cases, STAT and RAG diameters further increased to 4.0 mm and 4.7 mm, respectively, 3 months after operation. There was a positive correlation between STAT and RAG diameters (P = 0.0005). The STAT (P < 0.0001, P < 0.0001) and RAG (P < 0.0001, P = 0.0042) diameters were positively correlated with RAG flow and CBF, but the STAT (r2 = 0.762, P < 0.0001) and RAG (r2 = 0.54, P = 0.0042) diameters were negatively correlated with MTT. CONCLUSIONS: STAT-RA-MCA bypass combined with balloon occlusion of internal carotid artery is feasible for the treatment of complex internal carotid aneurysms.


Assuntos
Oclusão com Balão , Artéria Carótida Interna/cirurgia , Revascularização Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Artéria Radial/transplante , Artérias Temporais/cirurgia , Adulto , Idoso , Aneurisma Roto/etiologia , Aneurisma Roto/cirurgia , Circulação Cerebrovascular , Transtornos Cognitivos/etiologia , Estudos de Viabilidade , Feminino , Hemiplegia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Hemorragia Subaracnóidea/etiologia , Adulto Jovem
2.
Life Sci ; 241: 117163, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31837337

RESUMO

AIMS: The high sugar and lipid content of the Western diet (WD) is associated with metabolic dysfunction, non-alcoholic steatohepatitis, and it is an established risk factor for neuropsychiatric disorders. Our previous studies reported negative effects of the WD on rodent emotionality, impulsivity, and sociability in adulthood. Here, we investigated the effect of the WD on motor coordination, novelty recognition, and affective behavior in mice as well as molecular and cellular endpoints in brain and peripheral tissues. MAIN METHODS: Female C57BL/6 J mice were fed the WD for three weeks and were investigated for glucose tolerance, insulin resistance, liver steatosis, and changes in motor coordination, object recognition, and despair behavior in the swim test. Lipids and liver injury markers, including aspartate-transaminase, alanine-transaminase and urea were measured in blood. Serotonin transporter (SERT) expression, the density of Iba1-positive cells and concentration of malondialdehyde were measured in brain. KEY FINDINGS: WD-fed mice exhibited impaired glucose tolerance and insulin resistance, a loss of motor coordination, deficits in novel object exploration and recognition, increased helplessness, dyslipidemia, as well as signs of a non-alcoholic steatohepatitis (NASH)-like syndrome: liver steatosis and increased liver injury markers. Importantly, these changes were accompanied by decreased SERT expression, elevated numbers of microglia cells and malondialdehyde levels in, and restricted to, the prefrontal cortex. SIGNIFICANCE: The WD induces a spectrum of behaviors that are more reminiscent of ADHD and ASD than previously recognized and suggests that, in addition to the impairment of impulsivity and sociability, the consumption of a WD might be expected to exacerbate motor dysfunction that is also known to be associated with adult ADHD and ASD.


Assuntos
Transtornos Cognitivos/etiologia , Dieta Ocidental/efeitos adversos , Inflamação/etiologia , Transtornos Motores/etiologia , Hepatopatia Gordurosa não Alcoólica/etiologia , Córtex Pré-Frontal/patologia , Animais , Comportamento Animal , Transtornos Cognitivos/patologia , Feminino , Inflamação/patologia , Camundongos , Camundongos Endogâmicos C57BL , Transtornos Motores/patologia , Hepatopatia Gordurosa não Alcoólica/patologia , Córtex Pré-Frontal/imunologia
3.
Acta Neurochir Suppl ; 127: 175-178, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407081

RESUMO

Five frontal systems circuits connect with the basal ganglia and other structures to control and regulate thinking and behavior. Subarachnoid hemorrhage and stroke following anterior circulation aneurysms typically disrupt these circuits, sometimes markedly affecting a patient's function. This article reviews the primary pathways and associated brain functions. The principles of cognitively and behaviorally rehabilitating these functions are also discussed by creating external structure and building on what the brain is still capable of doing.


Assuntos
Transtornos Cognitivos , Acidente Vascular Cerebral , Hemorragia Subaracnóidea , Gânglios da Base , Encéfalo , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/reabilitação , Humanos , Acidente Vascular Cerebral/complicações , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/reabilitação
4.
Accid Anal Prev ; 134: 105328, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31639583

RESUMO

Patients with Parkinson's Disease (PD) often exhibit difficulties with visual search that may impede their ability to recognize landmarks and cars while driving. The main objective of this study was to investigate visual search performances of both billboards and cars in patients with PD using a driving simulator. A second objective was to examine the role of cognitive functions in performing the visual search task while driving. Nineteen patients with PD (age: 68 ±â€¯8yo, sex (Men/Women): 15/4) and 14 controls (age: 60 ±â€¯11yo, sex: 7/7) first performed a battery of cognitive tests. They then drove in a simulator and were instructed to follow a lead vehicle while searching for billboards with the letter A (stationary target) or red cars (moving target) among other distractors. Accuracy and response times of visual search were the main outcome variables. Standard deviation of lateral position (SDLP) was the secondary outcome. During driving, patients were less accurate in identifying the targets, particularly for the stationary billboards located in the outer periphery. Within the group of patients, significant correlations were found between several measures of cognitive tests and simulator-based visual search accuracy. By contrast, only the score on the MOCA test correlated significantly with visual search accuracy in controls. Findings suggest that patients with PD have impaired visual search for more eccentric stationary targets while driving a simulator, which is likely due to cognitive deficits. Difficulties identifying objects in the outer periphery may have implications for driving safety. Decreased functional field of view under increased cognitive load may have attributed to the difficulties identifying these landmarks. This may impact the ability to identify, anticipate, and respond to important information (e.g., pedestrians, navigation signs, landmarks), especially in complex driving situations (e.g. urban driving or intersections).Future studies should be conducted in a larger sample size to determine whether a visual search task on a driving simulator may predict on-road driving performances.


Assuntos
Condução de Veículo , Cognição/fisiologia , Doença de Parkinson/complicações , Transtornos da Visão/etiologia , Idoso , Estudos de Casos e Controles , Transtornos Cognitivos/etiologia , Simulação por Computador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desempenho Psicomotor/fisiologia
5.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(9. Vyp. 2): 37-43, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825388

RESUMO

Parkinson's disease is the second most common neurodegenerative disease of the elderly caused by the neurodegenerative process in different parts of the brain, which resulted in motor and non-motor symptoms. Investigation of non-motor symptoms of Parkinson's disease is increasingly rising for the last years. Social cognition is a special type of cognitive process, which provides people interaction in the society and their impairment also can be observed in Parkinson's disease. Social cognitive functions include many aspects: the theory of the mind, morality, personality changes and behavioral disorders. Each of these aspects is based on different neurophysiological, neurochemical and neuroanatomical substrates. This article is an effort to get closer to understanding of the changes, which occur in the brain of a patient with Parkinson's disease.


Assuntos
Transtornos Cognitivos , Doenças Neurodegenerativas , Doença de Parkinson , Comportamento Social , Idoso , Cognição , Transtornos Cognitivos/etiologia , Humanos , Doença de Parkinson/complicações
6.
Anasthesiol Intensivmed Notfallmed Schmerzther ; 54(11-12): 652-667, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31805585

RESUMO

Perioperative neurocognitive disorders (pNCD) are relevant to long term treatment outcome after elective surgery. The detection of pNCD is challenging and based on extended neuropsychological testing that often is not feasible due to economy driven time constraints during preoperative risk assessment. Only recently new recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery facilitated the transition of the former research diagnosis postoperative cognitive dysfunction (POCD) as a clinical diagnosis based on DSM-5 criteria. In our article we provide an overview of the new recommended diagnostic criteria for pNCD based on the publication by the Nomenclature Consensus Working Group in November 2018. We discuss ideas for the implementation of clinical routine pNCD screening in patients aged 70 years or older with elective surgery and possible options for further support of patients screened positively and their families and care givers.


Assuntos
Anestesia , Transtornos Cognitivos , Delírio , Idoso , Anestesia/efeitos adversos , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Delírio/diagnóstico , Delírio/etiologia , Humanos , Transtornos Neurocognitivos , Complicações Pós-Operatórias
8.
Life Sci ; 237: 116932, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31606384

RESUMO

The prevalence of dementia worldwide is growing at an alarming rate. A number of studies and meta-analyses have provided evidence for increased risk of dementia in patients with metabolic syndrome (MS) as compared to persons without MS. However, there are some reports demonstrating a lack of association between MS and increased dementia risk. In this review, taking into account the potential role of individual MS components in the pathogenesis of MS-related cognitive dysfunction, we considered the underlying mechanisms in arterial hypertension, diabetes mellitus, dyslipidemia, and obesity. The pathogenesis of dementia in MS is multifactorial, involving both vascular injury and non-ischemic neuronal death due to neurodegeneration. Neurodegenerative and ischemic lesions do not simply coexist in the brain due to independent evolution, but rather exacerbate each other, leading to more severe consequences for cognition than would either pathology alone. In addition to universal mechanisms of cognitive dysfunction shared by all MS components, other pathogenetic pathways leading to cognitive deficits and dementia, which are specific for each component, also play a role. Examples of such component-specific pathogenetic pathways include central insulin resistance and hypoglycemia in diabetes, neuroinflammation and adipokine imbalance in obesity, as well as arteriolosclerosis and lipohyalinosis in arterial hypertension. A more detailed understanding of cognitive disorders based on the recognition of underlying molecular mechanisms will aid in the development of new methods for prevention and treatment of devastating cognitive problems in MS.


Assuntos
Transtornos Cognitivos/etiologia , Transtornos Cognitivos/patologia , Demência/etiologia , Demência/patologia , Síndrome Metabólica/complicações , Síndrome Metabólica/patologia , Animais , Humanos , Fatores de Risco , Transdução de Sinais
9.
Rinsho Shinkeigaku ; 59(9): 570-574, 2019 Sep 25.
Artigo em Japonês | MEDLINE | ID: mdl-31474641

RESUMO

Here, we describe a case involving an 83-year-old woman who was admitted to our hospital for rehabilitation after pseudogout treatment. She had temporal and spatial disorientation. Neuropsychological assessment revealed frontal dysfunction, memory impairment, and executive dysfunction, in addition to general cognitive impairment. Subsequent laboratory examination revealed euthyroid status and elevated titers of anti-thyroid autoantibodies. MRI of the brain revealed no abnormal finding. However, electroencephalography revealed diffuse slowness. We diagnosed Hashimoto's encephalopathy on the basis of the clinical symptoms and laboratory findings. Administration of low-dose prednisolone (5 mg/day) alleviated general cognitive impairment and the laboratory findings; however, memory impairment and construction disorder remained. Previous studies suggest that the characteristics and clinical course of higher brain-function disorder associated with Hashimoto's encephalopathy vary on an individual basis, wherein some patients may respond well to low-dose steroid therapy. Here, we also encountered such a case, that showed good response to a low-dose steroid therapy.


Assuntos
Encéfalo/fisiopatologia , Encefalite/tratamento farmacológico , Encefalite/psicologia , Função Executiva , Glucocorticoides/administração & dosagem , Doença de Hashimoto/tratamento farmacológico , Doença de Hashimoto/psicologia , Prednisolona/administração & dosagem , Administração Oral , Idoso de 80 Anos ou mais , Transtornos Cognitivos/tratamento farmacológico , Transtornos Cognitivos/etiologia , Eletroencefalografia , Encefalite/complicações , Encefalite/diagnóstico , Feminino , Doença de Hashimoto/complicações , Doença de Hashimoto/diagnóstico , Humanos , Transtornos da Memória/etiologia , Resultado do Tratamento
10.
Int. j. clin. health psychol. (Internet) ; 19(3): 228-236, sept. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184969

RESUMO

Background/Objective: The current study aimed to examine the relationship between Posttraumatic Stress Disorder (PTSD) symptoms and executive dysfunction in children and adolescents after psychological trauma. Method: Participants were 13,438 of children and adolescents aged 6 to 18 years exposed to the 2008 Wenchuan earthquake. PTSD and dysexecutive symptoms were assessed using the UCLA PTSD Reaction Index for Children and the Self-Report Dysexecutive Questionnaire. Latent Profile Analysis (LPA) was conducted using Mplus version 7.4. Subgroup differences in trauma exposure and quality of life were calculated using ANCOVA. Results: A 4-class parallel model was found to best describe latent PTSD symptom profiles and executive dysfunction. Individuals in higher symptom groups showed more trauma exposure and lower quality of life. Conclusions: This LPA study shed light on the relationship between PTSD and executive dysfunction symptoms in children and adolescents. The correlation between PTSD and executive dysfunction was maintained after individual differences were taken into consideration. Our findings provide a new view on how PTSD relates to executive dysfunction and several suggestions for treating child and adolescent PTSD patients


Antecedentes/Objetivo: Se plantea examinar la relación entre síntomas del Trastorno de Estrés Postraumático (TEPT) y disfunción ejecutiva en niños y adolescentes después de un trauma psicológico. Método: Los participantes fueron 13,438 niños y adolescentes de 6 a 18 años de edad expuestos al terremoto de Wenchuan de 2008, a los que se le evaluaron síntomas de TEPT utilizando el UCLA PTSD Reaction Index for Children y síntomas de disfunción ejecutiva mediante el Self-Report Dysexecutive Questionnaire. Se realizó un Análisis de Perfil Latente (APL) mediante Mplus versión 7.4. Las diferencias de subgrupos en la exposición al trauma y la calidad de vida se calcularon utilizando ANCOVA. Resultados: Un modelo paralelo de 4-clases describe mejor los perfiles de síntomas de TEPT latentes y disfunción ejecutiva. Los grupos con síntomas más intensos mostraron mayor exposición al trauma y menor calidad de vida. Conclusiones: Se aclara la relación TEPT-síntomas de disfunción ejecutiva en niños y adolescentes. La correlación entre el trastorno de estrés postraumático y la disfunción ejecutiva se mantuvo después de considerar la heterogeneidad de la población. Se ofrece una nueva visión de cómo el TEPT se relaciona con la disfunción ejecutiva y varias sugerencias para tratar a pacientes jóvenes con TEPT


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Qualidade de Vida , Inquéritos e Questionários
11.
West Afr J Med ; 36(2): 158-164, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385602

RESUMO

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


Assuntos
Asma/diagnóstico , Transtornos Cognitivos/etiologia , Cognição/fisiologia , Desempenho Psicomotor/fisiologia , Adolescente , Adulto , Fatores Etários , Asma/complicações , Estudos de Casos e Controles , Transtornos Cognitivos/diagnóstico , Estudos Transversais , Humanos , Memória , Pessoa de Meia-Idade , Testes Neuropsicológicos , Nigéria
12.
Clin Interv Aging ; 14: 1243-1254, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31371930

RESUMO

Objective: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of cognitive stimulation therapy (CST) of different durations for Alzheimer's disease (AD). Methods: A comprehensive search was carried out in three databases. The primary outcome was Mini-Mental State Examination (MMSE) score. We conducted a meta-analysis with Review Manager, version 5.3 and assessed the methodological quality of the included studies using the Cochrane Collaboration Recommendations assessment tool. Results: Treatment effects from the meta-analysis showed that CST plus acetylcholinesterase inhibitors (ChEIs) was better than the control assessed by MMSE. In addition, the meta-analysis indicated that long-term CST was better than short-term or maintenance CST. Conclusion: Our study confirmed that the combination of CST and drug treatment for AD is effective in AD, regardless of whether short-term CST, maintenance CST, or long-term CST is used. The long-term CST appears to be more effective.


Assuntos
Doença de Alzheimer/terapia , Transtornos Cognitivos/terapia , Terapia Cognitivo-Comportamental/métodos , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico , Inibidores da Colinesterase/uso terapêutico , Transtornos Cognitivos/etiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Comportamento Social
13.
Psychol Aging ; 34(6): 766-779, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393145

RESUMO

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


Assuntos
Envelhecimento/fisiologia , Transtornos Cognitivos/etiologia , Cognição/fisiologia , Envelhecimento Cognitivo/psicologia , Disfunção Cognitiva/complicações , Disfunção Cognitiva/fisiopatologia , Perda Auditiva/complicações , Fatores Etários , Idoso , Envelhecimento/psicologia , Criança , Transtornos Cognitivos/diagnóstico , Feminino , Perda Auditiva/diagnóstico , Humanos , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Fatores de Risco
14.
Artigo em Inglês | MEDLINE | ID: mdl-31443272

RESUMO

Cognitive impairment is more prevalent in heart failure (HF) patients. Anemia can influence cognitive ability and is likely more prevalent in elderly patients with HF. However, there are limited data on the association of anemia with cognitive impairment in elderly HF patients. This study aimed to identify the association between anemia and cognitive impairment in elderly HF patients. This secondary data analysis included 181 patients aged 60 years or older with HF. Patients were categorized into an anemic or non-anemic group based on World Health Organization (WHO) criteria. We assessed the cognitive function using the Modified Mini-Mental State (3MS) at the time of enrollment. The prevalence of anemia and cognitive impairment in older patients with HF was the same at 35.4%. The main finding of the multiple logistic regression indicated that compared to a non-anemic status, anemia increased the risk of cognitive impairment (odds ratio (OR) = 4.268, 95% confidence interval (CI) = 1.898-9.593, p < 0.001). Healthcare providers should recognize the value of the significance of early assessment of anemic status and cognitive function following HF. A prospective cohort study should identify the pathway of the association between anemia and incidence of cognitive impairment.


Assuntos
Anemia/complicações , Transtornos Cognitivos/etiologia , Cognição/fisiologia , Disfunção Cognitiva/complicações , Insuficiência Cardíaca/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos
15.
BMJ ; 366: l4466, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391161

RESUMO

OBJECTIVE: To quantify the association between major surgery and the age related cognitive trajectory. DESIGN: Prospective longitudinal cohort study. SETTING: United Kingdom. PARTICIPANTS: 7532 adults with as many as five cognitive assessments between 1997 and 2016 in the Whitehall II study, with linkage to hospital episode statistics. Exposures of interest included any major hospital admission, defined as requiring more than one overnight stay during follow-up. MAIN OUTCOMES MEASURES: The primary outcome was the global cognitive score established from a battery of cognitive tests encompassing reasoning, memory, and phonemic and semantic fluency. Bayesian linear mixed effects models were used to calculate the change in the age related cognitive trajectory after hospital admission. The odds of substantial cognitive decline induced by surgery defined as more than 1.96 standard deviations from a predicted trajectory (based on the first three cognitive waves of data) was also calculated. RESULTS: After accounting for the age related cognitive trajectory, major surgery was associated with a small additional cognitive decline, equivalent on average to less than five months of aging (95% credible interval 0.01 to 0.73 years). In comparison, admissions for medical conditions and stroke were associated with 1.4 (1.0 to 1.8) and 13 (9.6 to 16) years of aging, respectively. Substantial cognitive decline occurred in 2.5% of participants with no admissions, 5.5% of surgical admissions, and 12.7% of medical admissions. Compared with participants with no major hospital admissions, those with surgical or medical events were more likely to have substantial decline from their predicted trajectory (surgical admissions odds ratio 2.3, 95% credible interval 1.4 to 3.9; medical admissions 6.2, 3.4 to 11.0). CONCLUSIONS: Major surgery is associated with a small, long term change in the average cognitive trajectory that is less profound than for major medical admissions. The odds of substantial cognitive decline after surgery was about doubled, though lower than for medical admissions. During informed consent, this information should be weighed against the potential health benefits of surgery.


Assuntos
Transtornos Cognitivos/epidemiologia , Disfunção Cognitiva/epidemiologia , Hospitalização/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Idoso , Transtornos Cognitivos/etiologia , Disfunção Cognitiva/etiologia , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
16.
Anesthesiol Clin ; 37(3): 521-536, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31337482

RESUMO

Postoperative delirium and postoperative cognitive dysfunction (POCD) occur commonly in older adults after surgery and are frequently underrecognized. Delirium has been associated with worse outcomes, and both delirium and cognitive dysfunction increase the risk of long-term cognitive decline. Although the pathophysiology of delirium and POCD have not been clearly defined, risk factors for both include increasing age, lower levels of education, and baseline cognitive impairment. In addition, developing delirium increases the risk of POCD. This article examines interventions that may reduce the risk of developing delirium and POCD and improve long-term recovery and outcomes in the vulnerable older population.


Assuntos
Encéfalo/crescimento & desenvolvimento , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Complicações Pós-Operatórias/psicologia , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/prevenção & controle , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/prevenção & controle , Delírio do Despertar/epidemiologia , Delírio do Despertar/prevenção & controle , Delírio do Despertar/psicologia , Humanos , Complicações Pós-Operatórias/prevenção & controle
17.
PLoS Med ; 16(7): e1002852, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31276501

RESUMO

BACKGROUND: Acute illness requiring hospitalization frequently is a sentinel event leading to long-term disability in older people. Prolonged bed rest increases the risk of developing cognitive impairment and dementia in acutely hospitalized older adults. Exercise protocols applied during acute hospitalization can prevent functional decline in older patients, but exercise benefits on specific cognitive domains have not been previously investigated. We aimed to assess the effects of a multicomponent exercise intervention for cognitive function in older adults during acute hospitalization. METHODS AND FINDINGS: We performed a secondary analysis of a single-blind randomized clinical trial (RCT) conducted from February 1, 2015, to August 30, 2017 in an Acute Care of the Elderly (ACE) unit in a tertiary public hospital in Navarre (Spain). 370 hospitalized patients (aged ≥75 years) were randomly allocated to an exercise intervention (n = 185) or a control (n = 185) group (usual care). The intervention consisted of a multicomponent exercise training program performed during 5-7 consecutive days (2 sessions/day). The usual care group received habitual hospital care, which included physical rehabilitation when needed. The main outcomes were change in executive function from baseline to discharge, assessed with the dual-task (i.e., verbal and arithmetic) Gait Velocity Test (GVT) and the Trail Making Test Part A (TMT-A). Changes in the Mini Mental State Examination (MMSE) test and verbal fluency ability were also measured after the intervention period. The physical exercise program provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 0.1 m/s (95% confidence interval [CI], 0.07, 0.13; p < 0.001) in the verbal GVT and 0.1 m/s (95% CI, 0.08, 0.13; p < 0.001) in the arithmetic GVT over usual care group. There was an apparent improvement in the intervention group also in the TMT-A score (-31.1 seconds; 95% CI, -49.5, -12.7 versus -3.13 seconds; 95% CI, -16.3, 10.2 in the control group; p < 0.001) and the MMSE score (2.10 points; 95% CI, 1.75, 2.46 versus 0.27 points; 95% CI, -0.08, 0.63; p < 0.001). Significant benefits were also observed in the exercise group for the verbal fluency test (mean 2.16 words; 95% CI, 1.56, 2.74; p < 0.001) over the usual care group. The main limitations of the study were patients' difficulty in completing all the tasks at both hospital admission and discharge (e.g., 25% of older patients were unable to complete the arithmetic GVT, and 47% could not complete the TMT-A), and only old patients with relatively good functional capacity at preadmission (i.e., Barthel Index score ≥60 points) were included in the study. CONCLUSIONS: An individualized, multicomponent exercise training program may be an effective therapy for improving cognitive function (i.e., executive function and verbal fluency domains) in very old patients during acute hospitalization. These findings support the need for a shift from the traditional (bedrest-based) hospitalization to one that recognizes the important role of maintaining functional capacity and cognitive function in older adults, key components of intrinsic capacity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02300896.


Assuntos
Repouso em Cama/efeitos adversos , Transtornos Cognitivos/prevenção & controle , Cognição , Terapia por Exercício , Hospitalização , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Função Executiva , Feminino , Nível de Saúde , Humanos , Masculino , Saúde Mental , Fatores de Risco , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Comportamento Verbal , Velocidade de Caminhada
18.
J Stroke Cerebrovasc Dis ; 28(9): 2376-2387, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31285116

RESUMO

BACKGROUND AND PURPOSE: Silent brain infarct (SBI), which has traditionally been considered clinically silent, has been proposed as a subclinical risk marker for future cognitive function decline. METHODS: We conducted a systematic review of literature in the Cochrane Library, MEDLINE, EMBASE, and the China National Knowledge Infrastructure database. RESULTS: In the end, 19 case-control studies, comprising 6712 participants, and 3 prospective cohort studies comprising 4433 participants, met all inclusion criteria and were included in the systematic review. Meta-analysis of 9 studies showed that SBI was an important factor in cognitive function decline (Mini-Mental State score) (standardized mean difference -.47, 95% confidence interval; -.72 to -.22). Another meta-analysis of 4 studies reported the SBI was an independent factor in cognitive dysfunction (Montreal Cognitive Assessment Scale) (standardized mean difference -3.36, 95% confidence interval; -5.90 to -.82). Ten studies further reported that SBI was associated with decreases in specific areas of cognitive function. CONCLUSIONS: These results suggest that rather than being clinically silent, SBI might be a factor inducing cognitive dysfunction.


Assuntos
Infarto Encefálico/complicações , Transtornos Cognitivos/etiologia , Cognição , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Infarto Encefálico/diagnóstico , Infarto Encefálico/psicologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
19.
J Stroke Cerebrovasc Dis ; 28(9): 2398-2406, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31311696

RESUMO

BACKGROUND: Coated-platelets are a subset of highly procoagulant platelets observed after dual agonist stimulation with collagen and thrombin. Coated-platelet levels are increased in acute stroke compared to controls, and higher levels are associated with stroke recurrence. We examined whether coated-platelet levels measured at the time of the stroke correlate with cognitive scores at 3 months following the brain infarction. METHODS: Coated-platelets were assayed in consecutive patients with nonlacunar stroke. Cognitive screening was performed using the Mini-Mental State Examination (MMSE) at 3 months after discharge. Linear regression, with adjustment for individual covariates, was used to model the association between coated-platelet levels and MMSE scores. RESULTS: One hundred and twenty-eight patients with a mean MMSE score of 26 points (range 14-30, standard deviation [SD] 3.1) and mean coated-platelet levels of 40.9% (range 5.2-76.2, SD 13.3), completed cognitive screening. An inverse linear association was found between coated-platelet levels and MMSE score, with higher levels seen in patients with lower MMSE scores (r = -.34, R2 = .12, P < .0001). This association remained despite adjustment for potential confounding factors. In the final model, higher coated-platelet levels (coefficient -.078, 95% confidence interval [CI]: -.12 to -.041, P < .0001), presence of hypertension (coefficient -2.42, 95% CI: -3.90 to -.95, P = .0015), and anticoagulant use at discharge (coefficient -1.48, 95% CI: -2.56 to -.39, P = .0079) were predictive of lower MMSE. CONCLUSIONS: These findings support a link between increased platelet procoagulant potential at the time of the stroke and development of cognitive impairment following cerebral infarction.


Assuntos
Coagulação Sanguínea , Plaquetas/metabolismo , Isquemia Encefálica/complicações , Transtornos Cognitivos/etiologia , Cognição , Ativação Plaquetária , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/psicologia , Transtornos Cognitivos/sangue , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Projetos Piloto , Contagem de Plaquetas , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia , Fatores de Tempo
20.
Lakartidningen ; 1162019 May 15.
Artigo em Sueco | MEDLINE | ID: mdl-31192413

RESUMO

According to previous research, a structured cardiac arrest follow-up may contribute to identifying health problems and the potential need of support among survivors and their relatives. However, a survey on post CA care and follow-up in Sweden, reported a lack of structure and major variations among Swedish hospitals. In 2016, Swedish guidelines were published with the aim to improve care. According to guidelines, all patients and their relatives should be offered a follow-up visit within 1-3 months after hospital discharge, including screening for cognitive and emotional problems and provision of information. More information is available at https://www.hlr.nu/vard-efter-hjartstopp/.


Assuntos
Assistência ao Convalescente/normas , Parada Cardíaca/terapia , Guias de Prática Clínica como Assunto , Sintomas Afetivos/etiologia , Transtornos Cognitivos/etiologia , Família , Parada Cardíaca/complicações , Humanos , Educação de Pacientes como Assunto , Qualidade de Vida , Sobreviventes , Suécia
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