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1.
Eur J Epidemiol ; 36(10): 1043-1054, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34370136

RESUMO

To examine the association of baseline body mass index (BMI) and BMI change with cognitive impairment among older adults in China. The study included data from the Chinese Longitudinal Healthy Longevity Study, a national community-based prospective cohort study from 2002 to 2018. Baseline BMI and BMI change were available for 12,027 adults aged older than 65 years. Cognitive impairment was defined as Chinese version of the Mini Mental State Examination score lower than 18. Multivariable Cox proportional hazard model was used. Among 12,027 participants (mean age was 81.23 years old and 47.48% were male), the proportion of underweight, normal, overweight and obese at baseline was 33.87%, 51.39%, 11.39% and 3.34%, respectively. During an average of 5.9 years' follow-up, 3086 participants (4.35 per 100 person-years) with incident cognitive impairment were identified. Compared with normal weight group, adjusted hazard ratio (AHR) for cognitive impairment was 0.86 (95% CI 0.75-0.99) among overweight group, whereas corresponding AHR was 1.02 (95% CI 0.94-1.10) in underweight and 1.01 (95% CI 0.80-1.28) in obese participants. Large weight loss (< -10%) was significantly associated with an increased risk of cognitive impairment (AHR, 1.42, 95% CI 1.29-1.56), compared to stable weight status group (-5% ~ 5%). In the restricted cubic spline models, BMI change showed a reverse J-shaped association with cognitive impairment. BMI-defined overweight, but not obesity, was associated with a lower risk of cognitive impairment among elderly Chinese adults, while large weight loss was associated with an increased risk. These findings are consistent with weight loss in the prodromal phase of dementia.


Assuntos
/psicologia , Índice de Massa Corporal , Peso Corporal , Transtornos Cognitivos/epidemiologia , Cognição/fisiologia , Estatura , China/epidemiologia , Transtornos Cognitivos/psicologia , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Prospectivos , Medição de Risco
2.
Nat Metab ; 3(8): 1058-1070, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34417591

RESUMO

Identifying secreted mediators that drive the cognitive benefits of exercise holds great promise for the treatment of cognitive decline in ageing or Alzheimer's disease (AD). Here, we show that irisin, the cleaved and circulating form of the exercise-induced membrane protein FNDC5, is sufficient to confer the benefits of exercise on cognitive function. Genetic deletion of Fndc5/irisin (global Fndc5 knock-out (KO) mice; F5KO) impairs cognitive function in exercise, ageing and AD. Diminished pattern separation in F5KO mice can be rescued by delivering irisin directly into the dentate gyrus, suggesting that irisin is the active moiety. In F5KO mice, adult-born neurons in the dentate gyrus are morphologically, transcriptionally and functionally abnormal. Importantly, elevation of circulating irisin levels by peripheral delivery of irisin via adeno-associated viral overexpression in the liver results in enrichment of central irisin and is sufficient to improve both the cognitive deficit and neuropathology in AD mouse models. Irisin is a crucial regulator of the cognitive benefits of exercise and is a potential therapeutic agent for treating cognitive disorders including AD.


Assuntos
Cognição , Fibronectinas/metabolismo , Hormônios/metabolismo , Condicionamento Físico Animal , Animais , Comportamento Animal , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/metabolismo , Transtornos Cognitivos/psicologia , Modelos Animais de Doenças , Fibronectinas/genética , Deleção de Genes , Expressão Gênica , Camundongos , Camundongos Knockout , Fenótipo
3.
J Neuropsychiatry Clin Neurosci ; 33(4): 307-313, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34261346

RESUMO

Cognitive control deficits are one of three primary endophenotypes in depression, and the enhanced targeting of these deficits in clinical and research work is expected to lead to improved depression outcomes. Cognitive control is a set of self-regulatory processes responsible for goal-oriented behavior that predicts clinical/functional outcomes across the spectrum of brain-based disorders. In depression, cognitive control deficits emerge by the first depressive episode, persist during symptom remission, and worsen over the course of depression. In addition, the presence of these deficits predicts a poor response to evidence-based depression treatments, including psychotherapy and antidepressant medication. This is particularly relevant to childhood depression, as 1%-2% of children are diagnosed with depression, yet there are very limited evidence-based treatment options. Cognitive control deficits may be a previously underaddressed factor contributing to poor outcomes, although there remains a dearth of research examining the topic. The investigators describe the prior literature on cognitive control in depression to argue for the need for increased focus on this endophenotype. They then describe cognitive control-focused clinical and research avenues that would likely lead to improved treatments and outcomes for this historically undertreated aspect of childhood depression.


Assuntos
Antidepressivos/uso terapêutico , Transtornos Cognitivos/psicologia , Depressão/tratamento farmacológico , Psicoterapia , Criança , Humanos
4.
Aging (Albany NY) ; 13(13): 17211-17226, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34197336

RESUMO

Saxitoxin (STX), as a type of paralytic shellfish poisoning (PSP), is gaining widespread attention due to its long existence in edible shellfish. However, the mechanism underlying STX chronic exposure-induced effect is not well understood. Here, we evaluated the neurotoxicity effects of long-term low-dose STX exposure on C57/BL mice by behavioral tests, pathology analysis, and hippocampal proteomics analysis. Several behavioral tests showed that mice were in a cognitive deficiency after treated with 0, 0.5, 1.5, or 4.5 µg STX equivalents/kg body weight in the drinking water for 3 months. Compared with control mice, STX-exposed mice exhibited brain neuronal damage characterized by decreasing neuronal cells and thinner pyramidal cell layers in the hippocampal CA1 region. A total of 29 proteins were significantly altered in different STX dose groups. Bioinformatics analysis showed that protein phosphatase 1 (Ppp1c) and arylsulfatase A (Arsa) were involved in the hippo signaling pathway and sphingolipid metabolism pathway. The decreased expression of Arsa indicates that long-term low doses of STX exposure can cause neuronal inhibition, which is a process related to spatial memory impairment. Taken together, our study provides a new understanding of the molecular mechanisms of STX neurotoxicity.


Assuntos
Síndromes Neurotóxicas/patologia , Saxitoxina/toxicidade , Animais , Comportamento Animal/efeitos dos fármacos , Região CA1 Hipocampal/patologia , Transtornos Cognitivos/induzido quimicamente , Transtornos Cognitivos/psicologia , Relação Dose-Resposta a Droga , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Transtornos da Memória/induzido quimicamente , Transtornos da Memória/psicologia , Camundongos , Camundongos Endogâmicos C57BL , Neurônios/patologia , Síndromes Neurotóxicas/psicologia , Proteômica , Células Piramidais/patologia
5.
Sci Rep ; 11(1): 12187, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108532

RESUMO

To determine whether there are differences in measures of cognitive function between second and third trimester pregnant women compared to non-pregnant controls. This prospective study comprised 40 pregnant and 40 non-pregnant women, 20-40 years old, native-Hebrew speakers who were recruited from the outpatient clinics during a period of nearly 2 years. The patients underwent cognitive and affective evaluation. The performance on the three following tests: difficult and total items of Verbal Paired Associates, the Digit Span-forward and the Naming Objects and Fingers test scores were significantly better among non- pregnant women. All the other test results were similar between the two groups, including the depression scores. On multivariate linear regression analysis, after adjusting for age and years of education , Verbal Paired Associates total score (p = 0.04), and Naming Objects and Fingers (p = 0.01) remained significantly associated with pregnancy, but not Digit Span (p = 0.09). Our study demonstrates an impairment in memory among pregnant women. Furthermore language skills, particularly naming, were also impaired, a finding which has not been previously described.


Assuntos
Transtornos Cognitivos/epidemiologia , Idioma , Testes Neuropsicológicos/estatística & dados numéricos , Adulto , Estudos de Casos e Controles , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Feminino , Humanos , Israel/epidemiologia , Gravidez , Estudos Prospectivos , Adulto Jovem
6.
Ann Neurol ; 90(2): 266-273, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34105176

RESUMO

OBJECTIVE: X-linked adrenoleukodystrophy (X-ALD) is a rare genetic disorder characterized by progressive demyelination ranging from mild myelopathic forms (adrenomyeloneuropathy [AMN]) to severe cerebral variants (adult cerebral adrenoleukodystrophy [ACALD]). The aim of this study was to compare cognitive function in adult-onset X-ALD phenotypes. METHODS: Cognitive function in various domains (intelligence, attention, memory, executive function, and processing speed) was assessed in 172 adults (117 with AMN, 30 with arrested ACALD, and 25 with acute ACALD) using comprehensive neuropsychological batteries. Phenotype differences were examined by analyses of variance. RESULTS: X-ALD phenotypes significantly differed in nonverbal intelligence, sustained attention, verbal encoding, nonverbal recognition, and processing speed (ps < 0.050). No group differences emerged regarding verbal intelligence, verbal retrieval and recognition, and executive function (ps > 0.050). Specifically, patients with acute ACALD showed severe cognitive deficits compared to AMN and normal data, with largest effects on processing speed. Contrary, cognition was overall intact in patients with AMN, independent of sex and corticospinal tract involvement, and those with arrested ACALD showed mild cognitive dysfunction, particularly in verbal encoding and processing speed. INTERPRETATION: Cerebral demyelination in patients with X-ALD causes white matter dementia, mainly characterized by an extreme slowdown in processing speed associated with deficits in attention and learning. Most patients with AMN show intact cognitive function. Future prospective, longitudinal studies with more sensitive imaging techniques are required to clarify whether early mild cognitive dysfunction found in some patients with AMN may be associated with subtle myelin abnormalities that do not yet appear as white matter lesions on cerebral MRI (cMRI) but have the potential to serve as early predictors of later cerebral progression. ANN NEUROL 2021;90:266-273.


Assuntos
Adrenoleucodistrofia/diagnóstico por imagem , Adrenoleucodistrofia/psicologia , Transtornos Cognitivos/diagnóstico por imagem , Transtornos Cognitivos/psicologia , Cognição/fisiologia , Fenótipo , Adolescente , Adrenoleucodistrofia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Adulto Jovem
7.
Neuropsychology ; 35(4): 335-351, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34043385

RESUMO

OBJECTIVE: Discuss anticipated patterns of cognitive and emotional dysfunction, prognostic indicators, and treatment considerations based on review of (a) neuroinvasive properties of prior human coronaviruses and (b) extensively researched disorders which share similar neurological mechanisms. METHOD: A web-based comprehensive search of peer-reviewed journals was conducted based on a variety of key terms (and variants of) including coronavirus, neuroinvasion, cognitive dysfunction, viral pandemics, respiratory illness, critical illness, and metabolic disease. Articles were chosen based on relevance to the current topic and ability to provide unique thematic information. Historical articles were included if these added scientific merit to recent literature. Review of information in widely disseminated news articles was followed-up with direct review of cited scientific literature. Databases searched included Google Scholar, PubMed, and Ovid Medline. RESULTS: Based on neuroinvasive properties of prior coronaviruses and existing research on similar neurophysiological conditions with detrimental cognitive effects, COVID-19-especially those with severe symptoms-are at risk for cognitive decline and significant psychiatric/behavioral sequela. CONCLUSIONS: There are few studies examining cognitive outcomes in COVID-19. This review argues that neuropsychological sequelae are to be expected in patients with COVID-19. Considerations for clinicians working with this unique population are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
COVID-19/psicologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Saúde Mental , Neuropsicologia , COVID-19/complicações , Humanos , Testes Neuropsicológicos , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Resultado do Tratamento
8.
Neuropsychology ; 35(4): 451-459, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34043394

RESUMO

OBJECTIVES: Neurocognitive disorders in Parkinson's disease (PD) are common and heterogeneous. The aim of this study was to use a data-driven method to describe different cognitive phenotypes in PD and to explore anxiety, depression, and motor disturbances across the different cognitive profiles. METHOD: Latent profile analysis was applied to the neuropsychological performances of 65 patients with idiopathic PD assessed by means of a battery of tests that encompass measures of attention, memory, executive functions, social cognition, language, and visuospatial abilities. RESULTS: A three-cluster model produced the best solution: Cluster A (21.54%) included patients with intact cognition or with a relatively slight cognitive impairment in memory and executive functioning; Cluster B (53.85%) included patients with an intermediate level of cognitive impairment; and Cluster C (24.61%) included patients with the most severe cognitive impairment, with greater deficit compared to Cluster B in executive functioning, and, notably, in tasks with a predominantly posterior cortical basis (naming and visuospatial abilities). The three subgroups did not differ in terms of age, gender, disease duration, motor symptom severity or side of onset, levodopa equivalent daily dose, level of anxiety, or depression; however, patients from Cluster C showed greater impairment than patients from Cluster A in measures of everyday functioning. CONCLUSIONS: We presented a qualitative description of three distinct cognitive phenotypes emerging from a sample of 65 PD patients. The three clusters seem to be related to daily functioning but are independent from the stage of disease, motor functioning, anxiety, and depression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Cognição , Doença de Parkinson/psicologia , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Ansiedade/psicologia , Atenção , Análise por Conglomerados , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Depressão/etiologia , Depressão/psicologia , Função Executiva , Feminino , Humanos , Idioma , Masculino , Memória , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/psicologia , Testes Neuropsicológicos , Doença de Parkinson/complicações , Fenótipo , Percepção Espacial
9.
J Neurochem ; 158(2): 328-341, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33871050

RESUMO

Post-operative cognitive dysfunction (POCD) is common and is associated with poor clinical outcome. Toll-like receptor (TLR) 3 and 4 have been implied in the development of POCD. The role of TLR2, a major brain TLR, in POCD is not clear. High mobility group box-1 (HMGB1) is a delayed inflammatory mediator and may play a role in POCD. The interaction between HMGB1 and TLRs in the perioperative period is not known. We hypothesize that TLR2 contributes to the development of POCD and that HMGB1 regulates TLR2 for this effect. To test these hypotheses, 6- to 8-week old male mice were subjected to right carotid artery exposure under isoflurane anesthesia. CU-CPT22, a TLR1/TLR2 inhibitor, at 3 mg/kg was injected intraperitoneally 30 min before surgery and 1 day after surgery. Glycyrrhizin, a HMGB1 antagonist, at 200 mg/kg was injected intraperitoneally 30 min before surgery. Mice were subjected to Barnes maze and fear conditioning tests from 1 week after surgery. Hippocampus and cerebral cortex were harvested 6 hr or 12 hr after the surgery for Western blotting, ELISA, immunofluorescent staining, and chromatin immunoprecipitation. There were neuroinflammation and impairment of learning and memory in mice with surgery. Surgery increased the expression of TLR2 and TLR4 but not TLR9 in the brain of CD-1 male mice. CU-CPT22 attenuated surgery-induced neuroinflammation and cognitive impairment. Similarly, surgery induced neuroinflammation and cognitive dysfunction in C57BL/6J mice but not in TLR2-/- mice. TLR2 staining appeared in neurons and microglia. Surgery increased HMGB1 in the cell nuclei of the cerebral cortex and hippocampus. Glycyrrhizin ameliorated this increase and the increase of TLR2 in the hippocampus after surgery. Surgery also increased the amount of tlr2 DNA precipitated by an anti-HMGB1 antibody in the hippocampus. Our results suggest that TLR2 contributes to surgery-induced neuroinflammation and cognitive impairment. HMGB1 up-regulates TLR2 expression in the hippocampus after surgery to facilitate this contribution. Thus, TLR2 and HMGB1 are potential targets for reducing POCD.


Assuntos
Benzocicloeptenos/uso terapêutico , Transtornos Cognitivos/prevenção & controle , Encefalite/genética , Encefalite/psicologia , Proteína HMGB1/antagonistas & inibidores , Complicações Pós-Operatórias/prevenção & controle , Receptor 2 Toll-Like/antagonistas & inibidores , Anestesia , Anestésicos Inalatórios , Animais , Comportamento Animal , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Ácido Glicirrízico/farmacologia , Proteína HMGB1/genética , Isoflurano , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Transtornos da Memória/induzido quimicamente , Transtornos da Memória/psicologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Complicações Pós-Operatórias/genética , Complicações Pós-Operatórias/psicologia , Receptor 2 Toll-Like/genética
10.
J Alzheimers Dis ; 81(2): 833-841, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33814432

RESUMO

BACKGROUND: In older people with cognitive impairment (CI), executive function (EF) has been associated with motor performance including balance and gait. The literature examining and supporting a relationship between balance performance and other cognitive domains is limited. OBJECTIVE: To investigate the relationship between global cognition and cognitive domain function and balance performance in older people with CI. METHODS: The iFOCIS randomized controlled trial recruited 309 community-dwelling older people with CI. Baseline assessments completed before randomization were used for analyses including the Addenbrooke's Cognitive Examination-III (ACE-III; global cognition) and its individual cognitive domains (attention; memory; verbal fluency; language; visuospatial ability) and the Frontal Assessment Battery (FAB), a measure of EF. A composite balance score was derived from postural sway and leaning balance tests. RESULTS: In linear regression analyses adjusted for covariates, global cognition and each cognitive domain were significantly associated with balance performance. EF (verbal fluency; ß= -0.254, p < 0.001, adjusted R2 = 0.387) and visuospatial ability (ß= -0.258, p < 0.001, adjusted R2 = 0.391) had the strongest associations with balance performance. In a comprehensively adjusted multivariable model including all of the ACE-III cognitive domains, visuospatial ability and EF (verbal fluency) were independently and significantly associated with balance performance. CONCLUSION: Poorer global cognition and cognitive domain function were associated with poorer balance performance in this sample of people with CI. Visuospatial ability and EF were independently associated with balance, highlighting potential shared neural networks and the role higher-level cognitive processes and spatial perception/processing play in postural control.


Assuntos
Envelhecimento/fisiologia , Transtornos Cognitivos/psicologia , Disfunção Cognitiva/psicologia , Vida Independente/psicologia , Idoso , Idoso de 80 Anos ou mais , Atenção/fisiologia , Cognição/fisiologia , Função Executiva/fisiologia , Marcha/fisiologia , Humanos , Masculino , Fatores de Risco
11.
J Alzheimers Dis ; 81(2): 545-555, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33814436

RESUMO

BACKGROUND: Very few studies have explored the utility of subjective cognitive complaints (SCCs) in primary care settings. OBJECTIVE: We aim to investigate associations between SCCs (item-level), objective cognitive function (across domains and global), and mood in a diverse primary care population, including subjects with mild cognitive impairment. METHODS: We studied 199 (75.9%females; 57.8%Hispanics; 42.2%African Americans) older adults (mean age 72.5 years) with memory concerns at a primary care clinic. A five-item SCC questionnaire, and objective cognitive assessments, including the Montreal Cognitive Assessment (MoCA) and the Geriatric Depression Scale, were administered. RESULTS: Logistic regression analyses showed associations between SCC score and depressive symptoms. A memory-specific ("memory worsening") SCC predicted scores on the MoCA (p = 0.005) in Hispanics. CONCLUSION: SCCs are strongly linked to depressive symptoms in African Americans and Hispanics in a primary care setting; a specific type of SCC is related to global cognitive function in Hispanics.


Assuntos
Envelhecimento/psicologia , Transtornos Cognitivos/psicologia , Cognição/fisiologia , Disfunção Cognitiva/psicologia , Atenção Primária à Saúde/estatística & dados numéricos , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Comparação Transcultural , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Masculino , Transtornos da Memória/psicologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Inquéritos e Questionários
12.
JAMA Netw Open ; 4(3): e213227, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33787912

RESUMO

Importance: The increasing prevalence of cognitive decline, impairment, and dementia spurs intense interest in cognitive preservation strategies. Objective: To explore the longitudinal association between physical activity (PA) and cognitive performance among women at midlife. Design, Setting, and Participants: This cohort study is an analysis from the Study of Women's Health Across the Nation. Enrollment occurred from 1996 through 1997, and follow-up extended into 2017. Included individuals were those who had undergone cognitive measures during the first 3 cognitive test visits and had at least 1 additional cognitive measurement. Stroke prior to baseline was an exclusion, and observations were censored for subsequent stroke. Data were analyzed from June 2018 through August 2019. Exposures: Engaging in sport or exercise PA (self-reported). Main Outcomes and Measures: The Symbol Digit Modalities Test (SDMT) was used to assess cognitive processing speed. The East Boston Memory Test-Delayed (EBMT-D) was used to measure verbal episodic memory. The digit span backwards (DSB) test was used to evaluate working memory. Results: Among 1718 women with a median (range) observation time of 11.9 (0.60-13.5) years, the mean (SD) baseline age was 45.7 (2.5) years. From baseline through age 61 years, mean change in SDMT score was -0.20 annually (95% CI, -0.26 to -0.15; P < .001). After age 61 years, the mean change in SDMT was -0.51 yearly (95% CI, -0.54 to -0.41; P < .001). Beginning at age 58 years of the mean change in EBMT was -0.03 yearly (95% CI, -0.04 to -0.02; P < .001). Starting at age 61 years, mean (SD) change in DSB was -0.03 annually (95% CI, -0.04 to -0.01; P = .001). When adjusted for attrition and practice effect, PA was associated with higher concurrent SDMT and EBMT scores and a smaller decrease in SDMT score. For each unit increment in PA, there was a 0.36 increment in concurrent SDMT score (95% CI, 0.14 to 0.59; P = .002) and a 0.10 increment in concurrent EBMT score (95% CI, 0.05 to 0.15; P < .001). Greater PA was associated with a smaller annual mean decrease in SDMT score (0.06 yearly; 95% CI, 0.02 to 0.09; P = .001). After additional adjustment for demographic characteristics, menopause symptoms, hormone therapy use, and the presence of diabetes and hypertension, PA was not associated with trajectories (ie, levels or slopes) of any cognitive outcome. Conclusions and Relevance: This cohort study found no association between greater PA levels and cognitive outcomes among women in midlife, unlike cohort studies that begin observations at later ages, which may be associated with confounding by reverse causation (ie, cognitive decline associated with an outcome of lower PA levels).


Assuntos
Transtornos Cognitivos/psicologia , Cognição/fisiologia , Exercício Físico/fisiologia , Memória/fisiologia , Saúde da Mulher , Adulto , Transtornos Cognitivos/fisiopatologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Neurology ; 96(19): e2395-e2406, 2021 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-33766994

RESUMO

OBJECTIVE: To assess the prevalence, timing, and functional impact of psychiatric, cognitive, and motor abnormalities in Huntington disease (HD) gene carriers, we analyzed retrospective clinical data from individuals with manifest HD. METHODS: Clinical features of patients with HD were analyzed for 6,316 individuals in an observational study of the European Huntington's Disease Network (REGISTRY) from 161 sites across 17 countries. Data came from clinical history and the patient-completed Clinical Characteristics Questionnaire that assessed 8 symptoms: motor, cognitive, apathy, depression, perseverative/obsessive behavior, irritability, violent/aggressive behavior, and psychosis. Multiple logistic regression was used to analyze relationships between symptoms and functional outcomes. RESULTS: The initial manifestation of HD is increasingly likely to be motor and less likely to be psychiatric as age at presentation increases and is independent of pathogenic CAG repeat length. The Clinical Characteristics Questionnaire captures data on nonmotor symptom prevalence that correlate specifically with validated clinical measures. Psychiatric and cognitive symptoms are common in HD gene carriers, with earlier onsets associated with longer CAG repeats. Of patients with HD, 42.4% reported at least 1 psychiatric or cognitive symptom before motor symptoms, with depression most common. Each nonmotor symptom was associated with significantly reduced total functional capacity scores. CONCLUSIONS: Psychiatric and cognitive symptoms are common and functionally debilitating in HD gene carriers. They require recognition and targeting with clinical outcome measures and treatments. However, because it is impossible to distinguish confidently between nonmotor symptoms arising from HD and primary psychiatric disorders, particularly in younger premanifest patients, nonmotor symptoms should not be used to make a clinical diagnosis of HD. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifier: NCT01590589.


Assuntos
Transtornos Cognitivos/epidemiologia , Doença de Huntington/epidemiologia , Internacionalidade , Transtornos Mentais/epidemiologia , Transtornos das Habilidades Motoras/epidemiologia , Testes Neuropsicológicos , Adulto , Idoso , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Feminino , Humanos , Doença de Huntington/diagnóstico , Doença de Huntington/psicologia , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Transtornos das Habilidades Motoras/diagnóstico , Transtornos das Habilidades Motoras/psicologia , Estudos Retrospectivos , Fatores de Tempo
14.
NeuroRehabilitation ; 48(2): 231-242, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33664160

RESUMO

BACKGROUND: Following mild-moderate traumatic brain injury (TBI), an individual experiences a range of emotional changes. It is often difficult for the patient to reconcile with their post-injury persona, and the memory of pre-injury personhood is particularly painful. Insight into one's cognitive deficits subsequent to injury can lead to an existential crisis and a sense of loss, including loss of self. OBJECTIVE: Restoration of cognitive functions and reconciliation with loss of pre-traumatic personhood employing a holistic method of neuropsychological rehabilitation in a patient suffering from TBI. METHODS: Ms. K.S, a 25-year-old female, presented with emotional disturbances following TBI. She reported both retrograde and anterograde amnesia. A multidimensional holistic rehabilitation was planned. Treatment addressed cognitive deficits through the basic functions approach. Cognitive behavioural methods for emotional regulation like diary writing helped reduce irritability and anger outbursts. Use of social media created new modes of memory activation and interactions. Compensatory strategies were used to recover lost skills, music-based attention training helped foster an individualised approach to the sense of one's body and self. RESULTS: As a result of these differing strategies, changes were reflected in neuro-psychological tests, depression score and the patient's self-evaluation. This helped generate a coherent self-narrative. CONCLUSION: Treatment challenges in such cases are increased due to patient's actual deficits caused by neuronal/biochemical changes. Innovative and multi-pronged rehabilitation strategies which involve everyday activities provided an answer to some of these problems. This method of rehabilitation may provide an optimistic context for future research.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Transtornos Cognitivos/reabilitação , Cognição/fisiologia , Saúde Holística/tendências , Musicoterapia/tendências , Recuperação de Função Fisiológica/fisiologia , Adulto , Lesões Encefálicas Traumáticas/psicologia , Transtornos Cognitivos/psicologia , Feminino , Humanos , Memória/fisiologia , Musicoterapia/métodos , Autoimagem
15.
Psychol Assess ; 33(6): 489-498, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33705161

RESUMO

The cognitive attentional syndrome (CAS), a multidimensional construct that consists of maladaptive forms of self-regulation, is central to the metacognitive model. Despite the CAS's central importance to the metacognitive model, as well as evidence that components of the CAS are risk factors for the development of emotional disorders, a psychometrically sound self-report measure that accounts for the multidimensional nature of the CAS has yet to be developed. The present set of studies details the development and initial validation of the Multidimensional Cognitive Attentional Syndrome Scale (MCASS). In study 1, a pool of 69 items, assessing the seven self-regulation strategies of the CAS, was administered to U.S. adults recruited through a crowd-sourcing website (N = 323). Structural analyses supported the proposed 7-factor solution and three items with the highest loadings on each factor, without salient cross-loadings, were retained. In Study 2, adult participants (N = 389) completed a battery of self-report measures, including the retained 21 MCASS items. The reduced item pool was examined using both first- and second-order measurement models. The 7-factor first-order measurement model and the second-order measurement model, with each of the first-order factors loading on a higher-order construct (i.e., CAS), provided adequate model fit. Each of the seven, first-order factors exhibited significant loadings on the second-order construct. Convergent, discriminant, and concurrent validity analyses further supported the construct validity of the MCASS scale scores. The MCASS may be particularly useful for examining the theoretical underpinnings of the metacognitive model, as well as for more comprehensive clinical monitoring of the CAS. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Transtornos Cognitivos/diagnóstico , Escalas de Graduação Psiquiátrica , Adulto , Atenção , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino , Metacognição , Pessoa de Meia-Idade , Modelos Psicológicos , Psicometria , Reprodutibilidade dos Testes , Autorrelato , Síndrome
16.
Medicine (Baltimore) ; 100(11): e25225, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33726020

RESUMO

BACKGROUND: The Cognitive Abilities Screening Instrument (CASI) assesses global cognitive function in people with dementia with 9 domains (i.e., long-term memory, short-term memory, concentration, orientation, attention, abstraction and judgment, language abilities, visual construction, and category fluency). However, the ecological, convergent, and discriminant validities of the CASI have not yet been examined. PURPOSE: This study designed to investigate these 3 validities of the CASI in people with dementia. METHODS: Fifty-eight participants underwent assessments with the CASI, 3 functional measures, and 3 cognitive measures. Pearson's r was used to estimate correlations among the CASI and 3 functional measures for examining ecological validity. We computed correlations (r) among the CASI and 3 functional measures for examining convergent validity. An independent t-test was applied to compare the levels of disability, and ceiling/floor effects were analyzed for examining discriminative validity. RESULTS: The CASI total score and domains had moderate to high correlations with 3 functional measures (r = 0.42-0.80), except in 2 CASI domains (i.e., attention and language). The CASI total score and domains showed moderate to high correlations with 3 cognitive measures (r = 0.45-0.93). The t-test results revealed significant differences (P < .05) in the CASI total score and other domains except for the short-term memory domains. Four domains of the CASI showed noticeable ceiling effects (22.4-39.7%). CONCLUSIONS: The CASI has adequate ecological validity, good convergent validity, and acceptable discriminative validity in people with dementia. The 5 domains with nonsignificant differences or ceiling effects should only be used with caution to distinguish people with dementia.


Assuntos
Transtornos Cognitivos/diagnóstico , Demência/psicologia , Avaliação Momentânea Ecológica/estatística & dados numéricos , Testes de Estado Mental e Demência/estatística & dados numéricos , Idoso , Transtornos Cognitivos/psicologia , Avaliação Momentânea Ecológica/normas , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência/normas , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
17.
J Alzheimers Dis ; 80(2): 527-532, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33554919

RESUMO

Hippocampal atrophy is seen in many neurodegenerative disorders and may be a cardinal feature of vascular neurodegeneration. We examined hippocampal volume (HV) in a group of ischemic stroke survivors with amyloid 18F-NAV4694 PET imaging three years after stroke. We compared HV between the amyloid-positive (n = 4) and amyloid-negative (n = 29) groups, and associations with co-morbidities using Charlson Comorbidity Indices and multi-way ANOVA. Amyloid status was not associated with verbal or visual delayed free recall memory indices or cognitive impairment. We found no association between amyloid status and HV in this group of ischemic stroke survivors.


Assuntos
Amiloide/metabolismo , Hipocampo/diagnóstico por imagem , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/metabolismo , Atrofia , Transtornos Cognitivos/metabolismo , Transtornos Cognitivos/psicologia , Estudos de Coortes , Comorbidade , Hipocampo/patologia , Imageamento por Ressonância Magnética , Transtornos da Memória/metabolismo , Transtornos da Memória/psicologia , Rememoração Mental , Testes Neuropsicológicos , Projetos Piloto , Tomografia por Emissão de Pósitrons , Comportamento Verbal
18.
Neurochirurgie ; 67(3): 290-294, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33621530

RESUMO

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repeated traumatic brain injury (TBI). This disorder is mainly observed in subjects at risk for brain traumatisms including boxers, American football and European football (soccer) players, as well as war veterans. Neuropathological findings are marked by abnormally phosphorylated tau accumulations at the depth of cerebral sulci, as well as TDP43, Aß and α-synuclein positive staining. It has been described 3 clinical variants: the behavioural/mood variant, the cognitive variant and the mixed behavioural/cognitive variant. Cerebral MRI revealed signs of diffuse atrophy with abnormal axonal findings using the diffusion tensor imaging methods. Cerebral PET tau revealed increased standardised uptake value ratio (SUVR) levels in various brain regions of CTE patients compared to controls. The place of CTE among other neurodegenerative diseases is still debated. The focus of CTE management must be on prevention. The best way to prevent CTE in athletes is to put in place strict and appropriate measures by physicians. An individual with concussion should not be allowed to play again immediately (and sometimes never) in cases of abnormal neurological symptoms or imaging abnormalities.


Assuntos
Encefalopatia Traumática Crônica/psicologia , Atletas , Biomarcadores , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Futebol Americano/lesões , Humanos , Transtornos Mentais/etiologia , Transtornos Mentais/psicologia , Proteínas tau/metabolismo
19.
Gait Posture ; 85: 157-163, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33578308

RESUMO

BACKGROUND: Individuals with Parkinson's disease (PD) who report freezing of gait (FOG) have poorer sleep quality than those without FOG. Cognitive, anxiety, and mobility disability are components of the FOG phenotype, however, no study has investigated if poor sleep quality is associated with all three components that underlie FOG in PD. RESEARCH QUESTION: Are there associations among sleep quality and all three components of the FOG phenotype? METHODS: Forty and 39 individuals with and without FOG (PD + FOG and PD-FOG), respectively, and 31 age-matched healthy controls (HC) participated in this study. Self-reported FOG (new-FOG questionnaire-NFOGQ), sleep quality (Pittsburgh Sleep Quality Index-PSQI), cognitive function (Montreal Cognitive Assessment-MoCA), anxiety (subscale from Hospital Anxiety and Depression Scale-HADS-A), and mobility (timed-up-and-go test-TUG) were assessed. RESULTS AND SIGNIFICANCE: PSQI scores were correlated with the scores of NFOGQ, MoCA, HADS-A, and TUG time in PD + FOG (P ≤ 0.0038). The multiple regression analysis identified the PSQI scores as the only predictor of the variance of the NFOGQ scores (R2 = 0.46, P < .0001). The variance in the PSQI scores were explained (69 %) by MoCA scores, NFOGQ scores, TUG time, and HADS-A scores (P ≤ 0.05). Although PD + FOG had a higher disease severity compared to PD-FOG (P < 0.001), disease severity did not enter in the regression model to explain PSQI scores and NFOGQ scores. We also observed associations of PSQI scores with the MoCA scores and TUG time for HC (P ≤ 0.0038), whereas there was no association between PSQI scores and any variable in PD-FOG (P > 0.05). Finally, PD + FOG presented worse scores of PSQI, MoCA, HADS-A, and TUG time than PD-FOG and HC (P < 0.05). Thus, poor sleep quality is associated with FOG and all three components that underlie FOG, regardless of the disease severity. Therefore, treatments useful to decrease FOG should be targeted to ameliorate sleep quality, cognition, anxiety, and mobility.


Assuntos
Ansiedade/etiologia , Transtornos Cognitivos/etiologia , Transtornos Neurológicos da Marcha/etiologia , Limitação da Mobilidade , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologia , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Idoso , Ansiedade/fisiopatologia , Ansiedade/psicologia , Estudos de Casos e Controles , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Avaliação da Deficiência , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Fatores de Risco , Autorrelato , Índice de Gravidade de Doença , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/psicologia
20.
PLoS One ; 16(2): e0246449, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33539468

RESUMO

The goal of this study was to test for long-term benefits three years after the completion of a cognitive training intervention (Project: EVO™) in a subset of children with Sensory Processing Dysfunction (SPD). Our initial findings revealed that children with SPD who also met research criteria for Attention Deficit Hyperactivity Disorder (SPD+IA) showed a significant decrease in parent-observed inattentive behaviors, which remained stable in a nine-month follow-up assessment. Forty nine caregivers of participants who completed the Project: EVO™ training were contacted to be included in this follow up study. Each was emailed an invitation to complete the Vanderbilt ADHD Diagnostic Parent Rating Scale, which yielded a completion rate of 39/49 (80%). A Generalized Estimating Equations analysis was used to assess changes in symptoms over time, specifically to determine whether the initial improvements were retained. The SPD+IA cohort continued to show sustained benefits on their parent-reported scores of inattention, with 54% of SPD+IA individuals no longer meeting criteria for ADHD three years following intervention. These findings provide initial insights into the potential long-term benefits of a digital health intervention for children with attention-based issues.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtornos Cognitivos/terapia , Adolescente , Atenção , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Cognição , Transtornos Cognitivos/psicologia , Terapia Cognitivo-Comportamental , Feminino , Seguimentos , Humanos , Masculino , Projetos Piloto , Sensação
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