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1.
Nat Commun ; 11(1): 4340, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32895386

RESUMO

Healthy cognitive ageing is a societal and public health priority. Cerebrovascular risk factors increase the likelihood of dementia in older people but their impact on cognitive ageing in younger, healthy brains is less clear. The UK Biobank provides cognition and brain imaging measures in the largest population cohort studied to date. Here we show that cognitive abilities of healthy individuals (N = 22,059) in this sample are detrimentally affected by cerebrovascular risk factors. Structural equation modelling revealed that cerebrovascular risk is associated with reduced cerebral grey matter and white matter integrity within a fronto-parietal brain network underlying executive function. Notably, higher systolic blood pressure was associated with worse executive cognitive function in mid-life (44-69 years), but not in late-life (>70 years). During mid-life this association did not occur in the systolic range of 110-140 mmHg. These findings suggest cerebrovascular risk factors impact on brain structure and cognitive function in healthy people.


Assuntos
Encéfalo/fisiopatologia , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cognitivos/fisiopatologia , Envelhecimento Saudável , Adulto , Idoso , Pressão Sanguínea , Mapeamento Encefálico/métodos , Córtex Cerebral/fisiopatologia , Estudos de Coortes , Função Executiva/fisiologia , Feminino , Substância Cinzenta/fisiopatologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Substância Branca/fisiopatologia
2.
Ideggyogy Sz ; 73(05-06): 199-205, 2020 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-32579310

RESUMO

Background and purpose: Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson's disease (PD). Alexithy-mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com-mon pathology of neuroanatomical structures. We hypo-thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective - The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Methods: Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale-20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Results: Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet-ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01). Conclusion: Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.


Assuntos
Sintomas Afetivos/diagnóstico , Transtornos Cognitivos/fisiopatologia , Depressão/psicologia , Doença de Parkinson/complicações , Adulto , Sintomas Afetivos/complicações , Sintomas Afetivos/psicologia , Idoso , Transtornos Cognitivos/complicações , Transtornos Cognitivos/psicologia , Disfunção Cognitiva , Depressão/complicações , Emoções , Humanos , Testes Neuropsicológicos , Doença de Parkinson/psicologia , Escalas de Graduação Psiquiátrica
3.
Arch Phys Med Rehabil ; 101(9): 1580-1589, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32540135

RESUMO

OBJECTIVE: To compare participants with Parkinson disease (PD) motor subtypes, postural instability and gait difficulty (PIGD) (n=46) and tremor dominant (TD) (n=28), in cognitive and motor-cognitive assessments with the purpose of identifying associations between subtype and visuospatial, whole-body spatial, inhibition and/or switching, and planning and/or organizational aspects of cognitive and motor-cognitive function. DESIGN: Retrospective cohort study. Fisher exact test was used for categorical variables, while 2-sample independent t tests were used to analyze continuous variables. SETTING: Assessments took place at Emory University. PARTICIPANTS: Participants (N=72) were 40 years and older, had a clinical diagnosis of PD, exhibited 3 of the 4 cardinal signs of PD, had shown benefit from antiparkinsonian medications, and were in Hoehn and Yahr stages I-IV. Participants could walk 3 m or more with or without assistance. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Balance and mobility tests included Fullerton Advanced Balance Scale and the time needed to turn 360 degrees. Cognitive assessments included Montreal Cognitive Assessment, Brooks Spatial Memory Task, Color-Word Interference Test, Tower of London, Trail Making Test, Corsi Blocks, Serial 3s Subtraction, and Body Position Spatial Task. Motor-cognitive function measures included Four Square Step Test and Timed Up and Go. RESULTS: Participants with PIGD performed lower than those with TD symptoms on mental status (P=.005), spatial memory (P=.027), executive function (P=.0001-.034), and visuospatial ability (P=.048). CONCLUSIONS: Findings suggest that PIGD subtype is linked to greater deficits in spatial cognition, attentional flexibility and organizational planning, and whole-body spatial memory domains. These findings support the need for more personalized approaches to clinically managing PD.


Assuntos
Doença de Parkinson/classificação , Doença de Parkinson/fisiopatologia , Idoso , Agnosia/fisiopatologia , Antiparkinsonianos/uso terapêutico , Transtornos Cognitivos/fisiopatologia , Função Executiva/fisiologia , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Doença de Parkinson/tratamento farmacológico , Equilíbrio Postural/fisiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Navegação Espacial/fisiologia
4.
BMC Neurol ; 20(1): 233, 2020 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-32505173

RESUMO

BACKGROUND: Interictal epileptiform discharges (IEDs) have been proven to impair cognitive function. However, it is not clear whether IEDs disrupt academic performance in children with idiopathic epilepsy, and the contribution of cognitive function deficits to impaired academic performance has not been clarified. This study aimed to examine the cognitive deficits and academic impairment in childhood idiopathic epilepsy with IEDs. METHODS: Ninety-seven childhood idiopathic epilepsy with IEDs, 77 childhood idiopathic epilepsy without IEDs, and 71 healthy controls completed a series of cognitive tests. We analyzed the cognitive performance in several domains including language, mathematics, psychomotor speed, spatial ability, memory, general intelligence, attention and executive functioning. Analysis of variance was conducted to compare the performance on all tests between the three groups. RESULTS: Childhood idiopathic epilepsy with IEDs exhibited not only general cognitive deficits in processing speed, spatial ability, and attention, but also arithmetic impairment. Furthermore, general cognitive deficits could account for the impaired arithmetic performance in childhood idiopathic epilepsy with IEDs. CONCLUSIONS: Our study suggested that IEDs in children with idiopathic epilepsy affected both cognitive function and academic performance, and that the cognitive deficits may be responsible for arithmetic performance impairment.


Assuntos
Desempenho Acadêmico/estatística & dados numéricos , Cognição/fisiologia , Epilepsia/fisiopatologia , Estudos de Casos e Controles , Criança , Transtornos Cognitivos/fisiopatologia , Feminino , Humanos , Masculino
5.
Rev. neurol. (Ed. impr.) ; 70(11): 406-412, 1 jun., 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-191900

RESUMO

INTRODUCCIÓN: La distrofia miotónica tipo 1 (DM1), o enfermedad de Steinert, es un trastorno multisistémico de herencia autosómica dominante, cuya variante adulta suele cursar con deterioro cognitivo multidominio y afectación de la funcionalidad y la calidad de vida de los pacientes. OBJETIVO: Estudiar la evolución a cuatro años del funcionamiento cognitivo de una muestra de pacientes con la variante adulta de DM1. PACIENTES Y MÉTODOS: Se evalúan las funciones cognitivas de una muestra de 31 pacientes con DM1, de los cuales 24 repiten la evaluación administrada hace cuatro años en el Servicio de Neurología del Complejo Hospitalario de Navarra. Se recogen datos de los dominios neurocognitivos más relacionados con los déficits de presentación habitual en la DM1. RESULTADOS: La evaluación de seguimiento constató la afectación de las funciones visuoespaciales y visuoconstructivas y de la atención alternante de los pacientes que se sometieron al estudio, así como de su funcionamiento cotidiano informado por la familia. Estos resultados están en línea con los obtenidos cuatro años atrás, sin que se haya objetivado un deterioro significativo entre ambas mediciones. Se demuestra, además, una mayor incidencia de deterioro cognitivo en 2018, con algunos casos de evolución a demencia en la enfermedad de Steinert. CONCLUSIÓN: La evolución neuropsicológica en la DM1 parece responder a un patrón progresivo, ligado a las funciones que más se afectan desde los inicios de la fase de secuelas y que suelen corresponder a los dominios de memoria de trabajo, atención alternante y habilidades visuoespaciales y visuoconstructivas


INTRODUCTION. Myotonic dystrophy type 1 (MD1), or Steinert's disease, is a multisystemic disorder of autosomal dominant inheritance, whose adult variant usually presents with multidomain cognitive impairment and affects patients' functionality and quality of life. AIM. To study the four-year history of cognitive functioning in a sample of patients with the adult variant of MD1. PATIENTS AND METHODS. The neurocognitive functions of a sample of 31 patients with MD1 are evaluated, of whom 24 repeat the test administered four years ago in the Neurology Service of the Complejo Hospitalario of Navarra. Data are collected from the cognitive domains that are most related to the deficits that usually present in MD1. RESULTS. The follow-up evaluation found that the visuospatial and visuoconstructive functions and alternating attention of the patients who underwent the study were affected, as was their daily functioning reported by the family. These results are in line with those obtained four years earlier, with no significant deterioration observed between the two measurements. A higher incidence of cognitive impairment was also displayed in 2018, with some cases of progression to dementia in Steinert's disease. CONCLUSION. Neurocognitive progression in MD1 seems to respond to a progressive pattern of degeneration, linked to the functions that are most affected from the beginning of the sequelae phase and which usually correspond to the domains of working memory, alternating attention, and visuospatial and visuoconstructive abilities


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Distrofia Miotônica/fisiopatologia , Distrofia Miotônica/complicações , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/etiologia , Testes Neuropsicológicos , Seguimentos
6.
J Stroke Cerebrovasc Dis ; 29(7): 104754, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32370925

RESUMO

BACKGROUND AND AIM: It is unclear whether blood pressure (BP) is associated with cognition after stroke. We examined associations between systolic and diastolic BP (SBP, DBP), pulse pressure (PP), mean arterial pressure (MAP), and cognition, each measured 90 days after stroke. METHODS: Cross-sectional analysis of prospectively obtained data of 432 dementia-free subjects greater than or equal to 45 (median age, 66; 45% female) with stroke (92% ischemic; median NIH stroke score, 3 [IQR, 2-6]) from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project in 2011-2013. PRIMARY OUTCOME: Modified Mini-Mental Status Examination (3MSE; range, 0-100). SECONDARY OUTCOMES: Animal Fluency Test (AFT; range, 0-10) and Trail Making Tests A and B (number of correct items [range, 0-25]/completion time [Trails A: 0-180 seconds; Trails B: 0-300 second]). Linear or tobit regression adjusted associations for age, education, and race/ethnicity as well as variables significantly associated with BP and cognition. RESULTS: Higher SBP, lower DBP, higher PP, and lower MAP each were associated with worse cognitive performance for all 4 tests (all P < .001). After adjusting for patient factors, no BP measures were associated with any of the 4 tests (all P > .05). Lower cognitive performance was associated with older age, less education, Mexican American ethnicity, diabetes, higher stroke severity, more depressive symptoms, and lower BMI. Among survivors with hypertension, anti-hypertensive medication use 90 days after stroke was significantly associated with higher AFT scores (P = .02) but not other tests (P > .15). CONCLUSIONS: Stroke survivors' BP levels were not associated with cognitive performance at 90 days independent of sociodemographic and clinical factors.


Assuntos
Pressão Sanguínea , Transtornos Cognitivos/etnologia , Cognição , Hipertensão/etnologia , Acidente Vascular Cerebral/etnologia , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Cognição/efeitos dos fármacos , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Estudos Transversais , Avaliação da Deficiência , Grupo com Ancestrais do Continente Europeu , Função Executiva , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Testes de Estado Mental e Demência , Americanos Mexicanos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prognóstico , Fatores de Risco , Determinantes Sociais da Saúde/economia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Texas/epidemiologia , Fatores de Tempo
7.
Brain ; 143(4): 1158-1176, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32243506

RESUMO

It is well established that chronic cognitive problems after traumatic brain injury relate to diffuse axonal injury and the consequent widespread disruption of brain connectivity. However, the pattern of diffuse axonal injury varies between patients and they have a correspondingly heterogeneous profile of cognitive deficits. This heterogeneity is poorly understood, presenting a non-trivial challenge for prognostication and treatment. Prominent amongst cognitive problems are deficits in working memory and reasoning. Previous functional MRI in controls has associated these aspects of cognition with distinct, but partially overlapping, networks of brain regions. Based on this, a logical prediction is that differences in the integrity of the white matter tracts that connect these networks should predict variability in the type and severity of cognitive deficits after traumatic brain injury. We use diffusion-weighted imaging, cognitive testing and network analyses to test this prediction. We define functionally distinct subnetworks of the structural connectome by intersecting previously published functional MRI maps of the brain regions that are activated during our working memory and reasoning tasks, with a library of the white matter tracts that connect them. We examine how graph theoretic measures within these subnetworks relate to the performance of the same tasks in a cohort of 92 moderate-severe traumatic brain injury patients. Finally, we use machine learning to determine whether cognitive performance in patients can be predicted using graph theoretic measures from each subnetwork. Principal component analysis of behavioural scores confirm that reasoning and working memory form distinct components of cognitive ability, both of which are vulnerable to traumatic brain injury. Critically, impairments in these abilities after traumatic brain injury correlate in a dissociable manner with the information-processing architecture of the subnetworks that they are associated with. This dissociation is confirmed when examining degree centrality measures of the subnetworks using a canonical correlation analysis. Notably, the dissociation is prevalent across a number of node-centric measures and is asymmetrical: disruption to the working memory subnetwork relates to both working memory and reasoning performance whereas disruption to the reasoning subnetwork relates to reasoning performance selectively. Machine learning analysis further supports this finding by demonstrating that network measures predict cognitive performance in patients in the same asymmetrical manner. These results accord with hierarchical models of working memory, where reasoning is dependent on the ability to first hold task-relevant information in working memory. We propose that this finer grained information may be useful for future applications that attempt to predict long-term outcomes or develop tailored therapies.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Encéfalo/fisiopatologia , Memória de Curto Prazo/fisiologia , Modelos Neurológicos , Rede Nervosa/fisiopatologia , Adulto , Transtornos Cognitivos/fisiopatologia , Conectoma , Imagem de Tensor de Difusão , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Resolução de Problemas/fisiologia
8.
Artigo em Russo | MEDLINE | ID: mdl-32323942

RESUMO

OBJECTIVE: Amplitude and latency of evoked potential P300 are considered as major correlates of cognitive functions. At the same time the changes in the theta-band event-related oscillations that appears at the same time window as P300 wave are less studied. The purpose of this study was to provide the complex assessment and comparison of neurophysiological indices of cognitive processes in healthy people and patients with personality disorder, schizotypal disorder and schizophrenia with different levels of cognitive dysfunction. MATERIAL AND METHODS: The total number of participants was 124, including 44 healthy volunteers, 40 schizophrenic patients, 22 patients with personality disorder, 18 patients with schizotypal disorder. Patients were examined in standard two-stimulus oddball paradigm. The P300 amplitude and latency, and evoked theta-band power and coherence were identified for target and non-target stimuli. RESULTS AND CONCLUSION: The decrease in P300 amplitude, prolongation of P300 latency, and reduction in the evoked theta-band power and coherence were revealed in all groups of patients compared to healthy subjects. These changes were spatially generalized and the most pronounced in schizophrenic patients. In patients with personality and schizotypal disorders, the changes had a local character, and didn't differ significantly when the groups were compared. The results show the gradual cognitive decline as follows: healthy patients, patients with schizotypal disorder, patients with personality disorder, and patients with schizophrenia. Such cognitive decline might be in line with the reduction of critical and prognostic abilities.


Assuntos
Potencial Evocado P300 , Transtornos da Personalidade/fisiopatologia , Esquizofrenia/fisiopatologia , Ritmo Teta , Transtornos Cognitivos/complicações , Transtornos Cognitivos/fisiopatologia , Eletroencefalografia , Potenciais Evocados Auditivos , Humanos , Transtornos da Personalidade/complicações , Esquizofrenia/complicações , Transtorno da Personalidade Esquizotípica/complicações , Transtorno da Personalidade Esquizotípica/fisiopatologia
10.
PLoS One ; 15(3): e0230436, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32210460

RESUMO

OBJECTIVES: Our aim was to compare neuropsychological and psychiatric outcomes across three encephalitis aetiological groups: Herpes simplex virus (HSV), other infections or autoimmune causes (Other), and encephalitis of unknown cause (Unknown). METHODS: Patients recruited from NHS hospitals underwent neuropsychological and psychiatric assessment in the short-term (4 months post-discharge), medium-term (9-12 months after the first assessment), and long-term (>1-year). Healthy control subjects were recruited from the general population and completed the same assessments. RESULTS: Patients with HSV were most severely impaired on anterograde and retrograde memory tasks. In the short-term, they also showed executive, IQ, and naming deficits, which resolved in the long-term. Patients with Other or Unknown causes of encephalitis showed moderate memory impairments, but no significant impairment on executive tests. Memory impairment was associated with hippocampal/medial temporal damage on magnetic resonance imaging (MRI), and naming impairment with left temporal and left frontal abnormalities. Patients reported more subjective cognitive complaints than healthy controls, with tiredness a significant problem, and there were high rates of depression and anxiety in the HSV and the Other encephalitis groups. These subjective, self-reported complaints, depression, and anxiety persisted even after objectively measured neuropsychological performance had improved. CONCLUSIONS: Neuropsychological and psychiatric outcomes after encephalitis vary according to aetiology. Memory and naming are severely affected in HSV, and less so in other forms. Neuropsychological functioning improves over time, particularly in those with more severe short-term impairments, but subjective cognitive complaints, depression, and anxiety persist, and should be addressed in rehabilitation programmes.


Assuntos
Transtornos Cognitivos/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Encefalite/fisiopatologia , Transtornos da Memória/fisiopatologia , Transtornos Cognitivos/diagnóstico por imagem , Transtornos Cognitivos/virologia , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/virologia , Depressão/fisiopatologia , Encefalite/diagnóstico por imagem , Encefalite/psicologia , Encefalite/virologia , Feminino , Hipocampo/diagnóstico por imagem , Hipocampo/fisiopatologia , Hipocampo/virologia , Humanos , Masculino , Memória/fisiologia , Transtornos da Memória/diagnóstico por imagem , Transtornos da Memória/virologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Simplexvirus/patogenicidade , Visão Ocular/fisiologia
11.
Cerebrovasc Dis ; 49(1): 10-18, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32023607

RESUMO

The symptoms related to insular ischemia have been the object of several studies in patients affected by stroke, although they are often accompanied by other ischemic alteration of adjacent brain structures supplied by the middle cerebral artery (MCA). The insula is vulnerable because of an ischemia due to thromboembolic vascular occlusion of the M1 MCA segment and the 2 main MCA branches (M2), mainly when they abruptly arise from the principal stem at a right angle. This topographical and anatomical peculiarity could enable an embolic formation, especially due to atrial fibrillation (AF), to occlude the transition pathway between M1 and M2, while the proximal origin of vascular supply protects the insula from ischemia due to hemodynamic factors. The aim of the study is to characterize the clinical aspects of acute ischemic strokes as a first event in the insular territory with specific attention to atypical manifestation. We have considered 233 patients with a first event stroke involving the insular territory and 13 cases of isolated insular stroke (IIS), from the stroke registry of the Policlinico "G.Martino", University of Messina, between the February 10, 2014 and the February 7, 2018. IIS patients showed CT/MRI lesions restricted to the insular region. Exclusion criteria were coexisting neurological diseases, structural brain lesions, extension to the subinsular area >50% of the total infarct volume. We identified 13 IIS patients (mean age 74 years), with an isolated symptom or a combination of typical and atypical aspects. Furthermore, we observed high frequency detection of cardiac disturbances. To our knowledge, just a few previous studies have described IIS; their incidence is still not well defined. IIS manifested with a combination of deficits including motor, somatosensory, speaking, coordination, autonomic and cognitive disturbances. After an ischemic stroke, AF manifestation could follow briefly the major event and its duration could be very short, as an autonomic dysfunction due to an insular infarction. This clinical condition requires a continuous cardiac monitoring for this dangerous occurrence.


Assuntos
Córtex Cerebral/irrigação sanguínea , Circulação Cerebrovascular , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Afasia/etiologia , Afasia/fisiopatologia , Afasia/psicologia , Ataxia/etiologia , Ataxia/fisiopatologia , Ataxia/psicologia , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Sistema Nervoso Autônomo/fisiopatologia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/fisiopatologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Avaliação da Deficiência , Feminino , Humanos , Itália , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Atividade Motora , Prognóstico , Sistema de Registros , Distúrbios Somatossensoriais/etiologia , Distúrbios Somatossensoriais/fisiopatologia , Distúrbios Somatossensoriais/psicologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Tomografia Computadorizada por Raios X
12.
Am J Occup Ther ; 74(1): 7401185060p1-7401185060p6, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32078511

RESUMO

IMPORTANCE: Previous research has calculated normative data for the Dynavision D2 Visuomotor Training (D2) System among healthy athletes to understand concussion management, but to date no studies have identified the norms for healthy adults over a large age range (18-80 yr) for physical response speed. OBJECTIVE: To provide normative data for the D2 for physical response speed in adults ages 18-80 yr. DESIGN: Cross-sectional, descriptive study to obtain normative data on physical response speed using the D2 for adults in age categories 18-40, 41-60, and 61-80 yr. SETTING: Genesis Physical Therapy and Wellness Center, a Midwestern outpatient hospital-based therapy center. PARTICIPANTS: Three hundred adults, stratified into three different age categories. Normal standards with quartiles were identified for each age and sex category. OUTCOMES AND MEASURES: Multiple regression model of the inverse response times. RESULTS: The results showed a significant difference in physical response speed between men and women and between the different age groups. Women in all age categories were slower than men. Physical response speed increased with age in both sexes, but each had significantly different age and sex main effects (p < .0005). CONCLUSIONS AND RELEVANCE: Occupational therapy practitioners can use the normative standards identified in this study in their assessment of clients with visual and cognitive deficits after a brain injury, stroke, or other neurologic pathology. WHAT THIS ARTICLE ADDS: This study's results can be added to the battery of other common evaluation measures that occupational therapists use to evaluate visual and cognitive deficits after neurological impairments.


Assuntos
Concussão Encefálica , Transtornos Cognitivos , Disfunção Cognitiva , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Concussão Encefálica/fisiopatologia , Transtornos Cognitivos/fisiopatologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Reação , Adulto Jovem
13.
PLoS One ; 15(2): e0229519, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32097438

RESUMO

BACKGROUND: Measures of cardiac ventricular electrophysiology have been associated with cognitive performance in cross-sectional studies. We sought to evaluate the association of worsening ventricular repolarization in midlife, as measured by incident prolonged QT interval, with cognitive decline in late life. METHODS: Midlife QT interval was assessed by electrocardiography during three study visits from 1965/68 to 1971/74 in a cohort of Japanese American men aged 46-68 at Exam 1 from the Honolulu Heart Study. We defined incident prolonged QT as the QT interval in the upper quartile at Exam 2 or 3 after QT interval in lower three quartiles at Exam 1. Cognitive performance was assessed at least once using the Cognitive Abilities Screening Instrument (CASI), scored using item response theory (CASI-IRT), during four subsequent visits from 1991/93 to 1999/2000 among 2,511 of the 4,737 men in the Honolulu-Asia Aging Study otherwise eligible for inclusion in analyses. We used marginal structural modeling to determine the association of incident prolonged QT with cognitive decline, using weighting to account for confounding and attrition. RESULTS: Incident prolonged QT interval in midlife was not associated with late-life CASI-IRT at cognitive baseline (estimated difference in CASI-IRT: 0.04; 95% CI: -0.28, 0.35; p = 0.81), or change in CASI-IRT over time (estimated difference in annual change in CASI-IRT: -0.002; 95%CI: -0.013, 0.010; p = 0.79). Findings were consistent across sensitivity analyses. CONCLUSIONS: Although many midlife cardiovascular risk factors and cardiac structure and function measures are associated with late-life cognitive decline, incident prolonged QT interval in midlife was not associated with late-life cognitive performance or cognitive decline.


Assuntos
Cognição/fisiologia , Frequência Cardíaca/fisiologia , Contração Miocárdica/fisiologia , Idoso , Envelhecimento , Americanos Asiáticos , Eletrofisiologia Cardíaca/métodos , Transtornos Cognitivos/fisiopatologia , Disfunção Cognitiva/complicações , Estudos de Coortes , Estudos Transversais , Humanos , Hipertensão/complicações , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos
14.
Clin Neurophysiol ; 131(3): 725-733, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32000073

RESUMO

OBJECTIVE: Cognitive deficits are core symptoms of schizophrenia; however, their pathophysiological mechanisms are still unclear. A sensory gating deficit, as reflected by P50 suppression, has been repeatedly shown in schizophrenia patients, which may be associated with cognitive deficits in this disorder. The present study was to examine the relationship between the P50 suppression and cognitive deficits in patients with schizophrenia, which is still under-investigated. METHOD: We recruited 38 chronic schizophrenia patients and 32 matched healthy controls, and assessed their cognition with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and P50 suppression with the electroencephalography system. RESULTS: The total and its 4 index scores (all p < 0.05) except for the visuospatial/ constructional index of RBANS were significantly lower in patients compared with healthy controls. However, only the language and attention passed Bonferroni corrections. Patients displayed a significantly higher P50 ratio, higher S2 amplitude, and lower S1 amplitude (all p < 0.05) than healthy controls. Interestingly, only in the patients, the S1 amplitude was associated with both language and attention, and the S2 amplitude with both visuospatial/ constructional and language (all p < 0.05), although all of these significances did not pass the Bonferroni corrections. The P50 ratio was not associated with any of the RBANS scores (all p > 0.05). CONCLUSIONS: Our results suggest the P50 suppression deficits in Chinese patients with schizophrenia, which may be associated with cognitive impairments of this illness. Moreover, the amplitude of S1 and the amplitude of S2 may be involved in the different cognitive domain deficits in schizophrenia patients. SIGNIFICANCE: This study suggests that the P50 components may possibly be effective biomarkers for cognitive deficits in patients with schizophrenia.


Assuntos
Cognição/fisiologia , Potenciais Evocados Auditivos/fisiologia , Esquizofrenia/fisiopatologia , Psicologia do Esquizofrênico , Adulto , Transtornos Cognitivos/complicações , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Eletroencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Esquizofrenia/complicações , Filtro Sensorial/fisiologia , Adulto Jovem
15.
Fortschr Neurol Psychiatr ; 88(1): 33-39, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31986550

RESUMO

The present review focuses on cognitive and participation impairments after aneurysmal subarachnoidal hemorrhage (aSAH). Such impairments may be present even in cases without evidence of damage in the neuropsychologically expected brain area. Neuroinflammation and oxidative stress may be responsible for this finding. Most frequently, cognitive impairment can be found in the verbal memory domain, visuospatial skills and memory domain, attention and working memory domain, executive functions (planning, central control, problem solving, attention, decision making), psychomotor speed and language domain. The presence of cognitive deficits is a major risk factor not to return to work again. Together with cognitive impairment, psychiatric symptoms like anxiety, depression and fatigue may be observed. Psychiatric disturbances result in impairments of social and vocational participation and - consecutively - worsening of quality of life.


Assuntos
Transtornos Cognitivos/complicações , Transtornos Cognitivos/fisiopatologia , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/fisiopatologia , Transtornos Cognitivos/psicologia , Função Executiva , Humanos , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Testes Neuropsicológicos , Qualidade de Vida , Hemorragia Subaracnóidea/psicologia
16.
Sci Rep ; 10(1): 1252, 2020 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-31988371

RESUMO

Patient stratification is critical for the sensitivity of clinical trials at early stages of neurodegenerative disorders. In Huntington's disease (HD), genetic tests make cognitive, motor and brain imaging measurements possible before symptom manifestation (pre-HD). We evaluated pre-HD stratification models based on single visit resting-state functional MRI (rs-fMRI) data that assess observed longitudinal motor and cognitive change rates from the multisite Track-On HD cohort (74 pre-HD, 79 control participants). We computed longitudinal performance change on 10 tasks (including visits from the preceding TRACK-HD study when available), as well as functional connectivity density (FCD) maps in single rs-fMRI visits, which showed high test-retest reliability. We assigned pre-HD subjects to subgroups of fast, intermediate, and slow change along single tasks or combinations of them, correcting for expectations based on aging; and trained FCD-based classifiers to distinguish fast- from slow-progressing individuals. For robustness, models were validated across imaging sites. Stratification models distinguished fast- from slow-changing participants and provided continuous assessments of decline applicable to the whole pre-HD population, relying on previously-neglected white matter functional signals. These results suggest novel correlates of early deterioration and a robust stratification strategy where a single MRI measurement provides an estimate of multiple ongoing longitudinal changes.


Assuntos
Disfunção Cognitiva/diagnóstico por imagem , Doença de Huntington/classificação , Doença de Huntington/fisiopatologia , Adulto , Encéfalo/patologia , Mapeamento Encefálico/métodos , Estudos de Casos e Controles , Transtornos Cognitivos/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Estudos de Coortes , Progressão da Doença , Diagnóstico Precoce , Feminino , Humanos , Doença de Huntington/metabolismo , Processamento de Imagem Assistida por Computador/métodos , Aprendizado de Máquina , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Exame Neurológico/métodos , Descanso
17.
Lancet Psychiatry ; 7(2): 191-207, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31732482

RESUMO

Cognitive symptoms are common, and yet many who seek help for cognitive symptoms neither have, nor go on to develop, dementia. A proportion of these people are likely to have functional cognitive disorders, a subtype of functional neurological disorders, in which cognitive symptoms are present, associated with distress or disability, but caused by functional alterations rather than degenerative brain disease or another structural lesion. In this Review, we have systematically examined the prevalence and clinical associations of functional cognitive disorders, and related phenotypes, within the wider cognitive disorder literature. Around a quarter of patients presenting to memory clinics received diagnoses that might indicate the presence of functional cognitive disorders, which were associated with affective symptoms, negative self-evaluation, negative illness perceptions, non-progressive symptom trajectories, and linguistic and behavioural differences during clinical interactions. Those with functional cognitive disorder phenotypes are at risk of iatrogenic harm because of misdiagnosis or inaccurate prediction of future decline. Further research is imperative to improve diagnosis and identify effective treatments for functional cognitive disorders, and better understanding these phenotypes will also improve the specificity of diagnoses of prodromal degenerative brain disease.


Assuntos
Sintomas Afetivos/fisiopatologia , Atitude Frente a Saúde , Transtornos Cognitivos/fisiopatologia , Sintomas Inexplicáveis , Transtornos da Memória/fisiopatologia , Sintomas Afetivos/epidemiologia , Transtornos Cognitivos/epidemiologia , Humanos , Transtornos da Memória/epidemiologia
18.
Biol Res Nurs ; 22(1): 5-12, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31409118

RESUMO

Low birth weight is an ongoing public health problem with severe consequences for those affected, including early morbidity and mortality and elevated risk for lifelong deficits in cognitive function. These deficits can be ameliorated by early intervention in many cases. To contribute to criteria for earlier identification of at-risk children prior to the onset of delays or deficits, we examined relationships between three gene candidates-SLC6A4, BDNF, COMT-and cognitive outcomes at school age in a secondary analysis of existing data from a nationally representative cohort. Single nucleotide polymorphism rs4074134, a variant of BDNF, and a rare insertion/deletion in the intron region of SLC6A4 were significant predictors of cognitive performance. Our final model predicted 17% of the variance in composite cognitive test scores among children with low birth weight at school age (F = 96.36, p < .001, R 2 = .17). Specifically, children homozygous for cytosine at rs4074134 scored .62 standard deviations higher on a measure of global cognition than children with one or more thymine. Similarly, children with an extra-long copy number variant of SLC6A4 scored .88 standard deviations higher than children who had one or more short forms of the gene. These findings support the potential for an approach to identifying children with low birth weights who are most at need of early intervention services. Future research should focus on validation of these findings in an independent sample and confirmation of the biological mechanisms through which these genes influence cognitive development.


Assuntos
Desenvolvimento Infantil/fisiologia , Transtornos Cognitivos/genética , Transtornos Cognitivos/fisiopatologia , Predisposição Genética para Doença , Recém-Nascido de Baixo Peso/fisiologia , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Criança , Transtornos Cognitivos/epidemiologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Fatores de Risco , Proteínas da Membrana Plasmática de Transporte de Serotonina/fisiologia , Estados Unidos/epidemiologia
19.
Brain ; 143(2): 503-511, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31840744

RESUMO

Adult-onset leukoencephalopathy with spheroids and pigmented glia (ALSP) is an autosomal dominant leukoencephalopathy caused by mutations in colony stimulating factor 1 receptor (CSF1R). Here we report clinical and imaging outcomes following allogeneic haematopoietic stem cell transplantation (HSCT) in two patients with ALSP at the University of California, San Francisco between January 2016 and December 2017. Patient 1 proceeded to transplantation at age 53 with a haplo-identical sibling donor. Patient 2, whose sister and mother had died of the disease, proceeded to transplantation at age 49 with a 12/12 human leukocyte antigen-matched unrelated donor. Both patients received reduced intensity conditioning regimens. At 28 and 26 months post-HSCT, respectively, both patients were alive, without evidence of graft-versus-host disease, with major infection at 1 year in one and new-onset seizures in the other. In both cases, neurological worsening continued post-HSCT; however, the progression in cognitive deficits, overall functional status and gait impairment gradually stabilized. There was continued progression of parkinsonism in both patients. On brain MRI, within 1 year there was stabilization of T2/FLAIR abnormalities, and after 2 years there was complete resolution of abnormal multifocal reduced diffusion. In summary, after >2 years of follow-up, allogeneic HSCT in ALSP led to interval resolution of diffusion MRI abnormalities, stabilization of T2/FLAIR MRI abnormalities, and partial clinical stabilization, supportive of treatment response. Allogeneic HSCT may be beneficial in ALSP by providing a supply of bone marrow-derived brain-engrafting myeloid cells with donor wild-type CSF1R to repopulate the microglial niche.


Assuntos
Encéfalo/fisiopatologia , Leucoencefalopatias/genética , Microglia/patologia , Neuroglia/citologia , Transtornos Cognitivos/patologia , Transtornos Cognitivos/fisiopatologia , Progressão da Doença , Feminino , Humanos , Leucoencefalopatias/terapia , Masculino , Pessoa de Meia-Idade , Mutação/genética , Receptores de Fator Estimulador das Colônias de Granulócitos e Macrófagos
20.
Rev. ORL (Salamanca) ; 11(1): 67-78, 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-193122

RESUMO

INTRODUCCIÓN Y OBJETIVO: El mareo y el desequilibrio son síntomas comunes en el anciano y tienen un gran impacto en su calidad de vida. MÉTODO: Revisión narrativa. RESULTADOS: Se revisan los principales factores que condicionan la inestabilidad en el anciano, el impacto de las caídas y las exploraciones más rentables desde el punto de vista diagnóstico y terapéutico en estos pacientes. Por último, se incide en la necesidad de un abordaje multidisciplinar destacando la importancia de la rehabilitación vestibular en el tratamiento de estos trastornos. CONCLUSIONES: La inestabilidad en el anciano es de origen multifactorial y no obedece solamente a razones fisiológicas. De ahí la necesidad de identificar los factores precipitantes, tratarlos si es posible y realizar un abordaje multidisciplinar que minimice la morbimortalidad asociada a este proceso y mejorando su calidad de vida. La rehabilitación vestibular puede mejorar significativamente el equilibrio de los ancianos con inestabilidad lo cual conduciría a una reducción significativa de las caídas


INTRODUCTION AND OBJECTIVE: Dizziness and imbalance are common symptoms in the elderly and have a great impact on their quality of life. METHOD: Narrative review. RESULTS: Main factors that condition instability in the elderly and the impact of falls are reviewed, as well as the most profitable tests in diagnosis. Finally, the need to perform a multidisciplinary approach was discussed, highlighting the importance of vestibular rehabilitation in the treatment of these disorders. CONCLUSIONS: Instability in the elderly is multifactorial and not only due to physiological reasons. Hence the need to identify precipitating factors, treat them if possible and carry out a multidisciplinary approach that minimizes the morbidity and mortality associated with this process and improve their quality of life. Vestibular rehabilitation can significantly ameliorate balance in the elderly with instability which would lead to a significant reduction in falls


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Doenças Vestibulares/reabilitação , Qualidade de Vida , Transtornos Cognitivos/fisiopatologia , Saúde do Idoso , Fenômenos Fisiológicos Musculoesqueléticos , Acidentes por Quedas , Fatores de Risco
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