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Sample records for numerical cognition impairments

  1. Young Children with Specific Language Impairment and Their Numerical Cognition.

    ERIC Educational Resources Information Center

    Arvedson, Paula J.

    2002-01-01

    Enumeration and numerical reasoning levels of 19 children with specific language impairment (SLI) were compared to children matched for age and children matched for grammatical ability (GM). Children with SLI performed better than the GM group on reproduction of sets, numerosity of sets, an addition/subtraction condition, and transformation…

  2. Anatomical substrates and neurocognitive predictors of daily numerical abilities in mild cognitive impairment.

    PubMed

    Benavides-Varela, Silvia; Burgio, Francesca; Meneghello, Francesca; De Marco, Matteo; Arcara, Giorgio; Rigon, Jessica; Pilosio, Cristina; Butterworth, Brian; Venneri, Annalena; Semenza, Carlo

    2015-10-01

    Patients with mild cognitive impairment experience difficulties in mathematics that affect their functioning in the activities of everyday life. What are the associated anatomical brain changes and the cognitive correlates underlying such deficits? In the present study, 33 patients with Mild Cognitive Impairments (MCI) and 29 cognitively normal controls underwent volumetric MRI, and completed the standardized battery of Numerical Activities of Daily Living (NADL) along with a comprehensive clinical neuropsychological assessment. Group differences were examined on the numerical tasks and volumetric brain measures. The gray (GM) and white matter (WM) volume correlates were also evaluated. The results showed that relative to controls, the MCI group had impairments in number comprehension, transcoding, written operations, and in daily activities involving time estimation and money usage. In the volumetric measures, group differences emerged for the transcoding subtask in the left insula and left superior temporal gyrus. Among MCI patients, number comprehension and formal numerical performance were correlated with volumetric variability in the right middle occipital areas and right frontal gyrus. Money-usage scores showed significant correlations with left mesial frontal cortex, right superior frontal and right superior temporal cortex. Regression models revealed that neuropsychological measures of long-term memory, language, visuo-spatial abilities, and abstract reasoning were predictive of the patients' decline in daily activities. The present findings suggest that early neuropathology in distributed cortical regions of the brain including frontal, temporal and occipital areas leads to a breakdown of cognitive abilities in MCI that impacts on numerical daily functioning. The findings have implications for diagnosis, clinical and domestic care of patients with MCI. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Vascular Cognitive Impairment.

    PubMed

    Dichgans, Martin; Leys, Didier

    2017-02-03

    Cerebrovascular disease typically manifests with stroke, cognitive impairment, or both. Vascular cognitive impairment refers to all forms of cognitive disorder associated with cerebrovascular disease, regardless of the specific mechanisms involved. It encompasses the full range of cognitive deficits from mild cognitive impairment to dementia. In principle, any of the multiple causes of clinical stroke can cause vascular cognitive impairment. Recent work further highlights a role of microinfarcts, microhemorrhages, strategic white matter tracts, loss of microstructural tissue integrity, and secondary neurodegeneration. Vascular brain injury results in loss of structural and functional connectivity and, hence, compromise of functional networks within the brain. Vascular cognitive impairment is common both after stroke and in stroke-free individuals presenting to dementia clinics, and vascular pathology frequently coexists with neurodegenerative pathology, resulting in mixed forms of mild cognitive impairment or dementia. Vascular dementia is now recognized as the second most common form of dementia after Alzheimer's disease, and there is increasing awareness that targeting vascular risk may help to prevent dementia, even of the Alzheimer type. Recent advances in neuroimaging, neuropathology, epidemiology, and genetics have led to a deeper understanding of how vascular disease affects cognition. These new findings provide an opportunity for the present reappraisal of vascular cognitive impairment. We further briefly address current therapeutic concepts.

  4. Overlapping Numerical Cognition Impairments in Children with Chromosome 22q11.2 Deletion or Turner Syndromes

    ERIC Educational Resources Information Center

    Simon, T. J.; Takarae, Y.; DeBoer, T.; McDonald-McGinn, D. M.; Zackai, E. H.; Ross, J. L.

    2008-01-01

    Children with one of two genetic disorders (chromosome 22q11.2 deletion syndrome and Turner syndrome) as well typically developing controls, participated in three cognitive processing experiments. Two experiments were designed to test cognitive processes involved in basic aspects numerical cognition. The third was a test of simple manual motor…

  5. Overlapping Numerical Cognition Impairments in Children with Chromosome 22q11.2 Deletion or Turner Syndromes

    ERIC Educational Resources Information Center

    Simon, T. J.; Takarae, Y.; DeBoer, T.; McDonald-McGinn, D. M.; Zackai, E. H.; Ross, J. L.

    2008-01-01

    Children with one of two genetic disorders (chromosome 22q11.2 deletion syndrome and Turner syndrome) as well typically developing controls, participated in three cognitive processing experiments. Two experiments were designed to test cognitive processes involved in basic aspects numerical cognition. The third was a test of simple manual motor…

  6. Mild Cognitive Impairment.

    PubMed

    Sanford, Angela M

    2017-08-01

    Mild cognitive impairment (MCI) occurs along a continuum from normal cognition to dementia. A roadblock to earlier diagnosis and potential treatment is the lack of consistency with screening for MCI. Universal screening would be ideal, but is limited. Once a diagnosis of MCI is made, it is important for the clinician to evaluate for reversible causes. At present time, there are no pharmacologic treatments proven to slow or cure progression of MCI to dementia; nonetheless, there is evidence that lifestyle modifications including diet, exercise, and cognitive stimulation may be effective. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Cognitive impairment and pragmatics.

    PubMed

    Gutiérrez-Rexach, Javier; Schatz, Sara

    2016-01-01

    One of the most important ingredients of felicitous conversation exchanges is the adequate expression of illocutionary force and the achievement of perlocutionary effects, which can be considered essential to the functioning of pragmatic competence. The breakdown of illocutionary and perlocutionary functions is one of the most prominent external features of cognitive impairment in Alzheimer's Disease, with devastating psychological and social consequences for patients, their family and caregivers. The study of pragmatic functions is essential for a proper understanding of the linguistic and communicative aspects of Alzheimer's disease.

  8. Cognitive Impairment and Tramadol Dependence.

    PubMed

    Bassiony, Medhat M; Youssef, Usama M; Hassan, Mervat S; Salah El-Deen, Ghada M; El-Gohari, Hayam; Abdelghani, Mohamed; Abdalla, Ahmed; Ibrahim, Dalia H

    2017-02-01

    Cognitive impairment is one of the consequences of substance abuse. Tramadol abuse is a public health problem in Egypt. The objective of this study was to estimate the prevalence and correlates of cognitive impairment among tramadol-abuse patients and control subjects. This study included 100 patients with tramadol abuse and 100 control subjects (matched for age, sex, and education) who were recruited from Zagazig University Hospital, Egypt. Patients were divided into 2 groups: patients who used tramadol only (tramadol-alone group) and patients who used tramadol and other substances (polysubstance group). The participants were interviewed using Montreal Cognitive Assessment test and had urine screening for drugs. Twenty-four percent of the cases used tramadol alone, whereas the remaining used tramadol and other substances, mainly cannabis (66%) and benzodiazepines (27%). Tramadol-abuse patients were about 3 times more likely to have cognitive impairment than control subjects (81% vs 28%). Tramadol-alone patients were more than 2 times more likely to have cognitive impairment than control subjects (67% vs 28%). Cognitive impairment was significantly associated with polysubstance abuse. There was no association between cognitive impairment and sociodemographic or clinical factors. Cognitive impairment occurs commonly among tramadol-abuse patients. Memory impairment is the most common cognitive domain to be affected. There is a significant association between cognitive impairment and polysubstance abuse.

  9. Vascular cognitive impairment and dementia

    PubMed Central

    Gorelick, Philip B.; Counts, Scott E.; Nyenhuis, David

    2016-01-01

    Vascular contributions to cognitive impairment are receiving heightened attention as potentially modifiable factors for dementias of later life. These factors have now been linked not only to vascular cognitive disorders but also Alzheimer’s disease. In this chapter we review 3 related topics that address vascular contributions to cognitive impairment: 1. vascular pathogenesis and mechanisms; 2. neuropsychological and neuroimaging phenotypic manifestations of cerebrovascular disease; and 3. prospects for prevention of cognitive impairment of later life based on cardiovascular and stroke risk modification.1 PMID:26704177

  10. Psychiatric Issues in Cognitive Impairment

    PubMed Central

    Aarsland, Dag; Taylor, John-Paul; Weintraub, Daniel

    2015-01-01

    Neuropsychiatric symptoms (NPS) such as depression, hallucinations and apathy commonly occur in Parkinson’s disease (PD) and have major clinical consequences including a negative impact on quality of life. This review discusses the epidemiology, clinical features, diagnostic procedures and treatment issues of NPS in PD and related disorders in the perspective of cognitive impairment, focusing on depression, anxiety, visual hallucinations, apathy, sleep disturbances, impulse control disorder and non-motor fluctuations. The majority of NPS are more common in PD patients with dementia, possibly related to shared underlying pathologies. Recent studies also suggest that NPS are associated with mild cognitive impairment in PD, in particular with the amnestic type. Accurate diagnosis of NPS is important but can be difficult, due to overlapping symptoms and similar appearance of symptoms of motor symptoms of parkinsonism, cognitive impairment, mood disorders and apathy. There are few systematic studies focusing on the management of NPS in PD with cognitive impairment. PMID:24757113

  11. Hypertension and mild cognitive impairment.

    PubMed

    Sierra, Cristina; Doménech, Mónica; Camafort, Miguel; Coca, Antonio

    2012-12-01

    The brain is an early target for organ damage due to high blood pressure. Hypertension is the major modifiable risk factor for stroke and small vessel disease. It has been suggested that cerebral microvascular disease contributes to vascular cognitive impairment. The mechanisms underlying hypertension-related cognitive changes are complex and not yet fully understood. Both high and, especially in the elderly, low blood pressure (BP) have been linked to cognitive decline and dementia. There is some evidence that antihypertensive drug treatment could play a role in the prevention of cognitive impairment through BP control. The BP levels that should be targeted to achieve optimal perfusion while preventing cognitive decline are still under debate.

  12. Epigenetic treatments for cognitive impairments.

    PubMed

    Day, Jeremy J; Sweatt, J David

    2012-01-01

    Epigenetic mechanisms integrate signals from diverse intracellular transduction cascades and in turn regulate genetic readout. Accumulating evidence has revealed that these mechanisms are critical components of ongoing physiology and function in the adult nervous system, and are essential for many cognitive processes, including learning and memory. Moreover, a number of psychiatric disorders and syndromes that involve cognitive impairments are associated with altered epigenetic function. In this review, we will examine how epigenetic mechanisms contribute to cognition, consider how changes in these mechanisms may lead to cognitive impairments in a range of disorders and discuss the potential utility of therapeutic treatments that target epigenetic machinery. Finally, we will comment on a number of caveats associated with interpreting epigenetic changes and using epigenetic treatments, and suggest future directions for research in this area that will expand our understanding of the epigenetic changes underlying cognitive disorders.

  13. Cognitive impairment in bipolar disorder.

    PubMed

    Latalova, Klara; Prasko, Jan; Diveky, Tomas; Velartova, Hana

    2011-03-01

    Provide an overview of how bipolar disorder affects cognitive function in patients. MEDLINE and PsycInfo data bases were searched for articles indexed by the combinations of MESH term or key word "bipolar disorder" with the following terms: "cognition", "memory", "neuropsychology", "neuropsychological tests", "lithium", "anticonvulsants", "antipsychotics", and "schizophrenia". Constraints limiting time period of publications or their language were not applied. Reference lists of publications identified by these procedures were hand-searched for additional relevant citations. There is evidence of stable and lasting cognitive impairment in all phases of bipolar disorder, including the remission phase, particularly in the following domains: sustained attention, memory and executive functions. But research on the cognitive functions has yielded inconsistent results over recent years. There is a growing need for clarification regarding the magnitude, clinical relevance and confounding variables of cognitive impairment in bipolar patients. The impact of bipolar illness on cognition can be influenced by age of onset, pharmacological treatments, individual response, familial risk factors, and clinical features. In addition to the mood state, cognitive performance in bipolar patients is influenced by seasonality. Previous optimistic assumptions about the prognosis of bipolar disorder were based on the success of the control of mood symptoms by pharmacotherapy. However, it is now clear that the "remitted" euthymic bipolar patients have distinct impairments of executive function, verbal memory, psychomotor speed, and sustained attention. Mood stabilizers and atypical antipsychotics may reduce cognitive deficits in certain domains and may have a positive effect on quality of life and social functioning.

  14. Assessing cognitive impairment following stroke.

    PubMed

    McDonnell, Michelle N; Bryan, Janet; Smith, Ashleigh E; Esterman, Adrian J

    2011-11-01

    The assessment of cognitive function is often neglected following stroke, with no consensus on the optimal method to assess poststroke cognition. We evaluated the ability of a brief protocol to detect cognitive impairment in community-dwelling people with chronic stroke compared to healthy controls and its ability to detect changes in cognition in stroke participants undergoing an exercise intervention. Four tests of cognition were able to detect differences between the groups in the domains of executive function, memory, and information-processing speed. Stroke survivors undergoing exercise over a 5-month period showed significantly improved memory and speed of information processing. Results suggest that exercise may have the potential to improve cognition in long-term stroke survivors and that these tests are sensitive measures of poststroke cognition.

  15. Mild Cognitive Impairment (MCI)

    MedlinePlus

    ... MCI) is an intermediate stage between the expected cognitive decline of normal aging and the more-serious decline of dementia. It can involve problems with memory, language, thinking and judgment that are greater than normal ...

  16. Parkinson's Disease and Cognitive Impairment.

    PubMed

    Yang, Yang; Tang, Bei-Sha; Guo, Ji-Feng

    2016-01-01

    Parkinson's disease (PD) is a progressive neurodegenerative disease primarily characterized by the hallmarks of motor symptoms, such as tremor, bradykinesia, rigidity, and postural instability. However, through clinical investigations in patients and experimental findings in animal models of Parkinson's disease for years, it is now well recognized that Parkinson's disease is more than just a motor-deficit disorder. The majority of Parkinson's disease patients suffer from nonmotor disabilities, for instance, cognitive impairment, autonomic dysfunction, sensory dysfunction, and sleep disorder. So far, anti-PD prescriptions and surgical treatments have been mainly focusing on motor dysfunctions, leaving cognitive impairment a marginal clinical field. Within the nonmotor symptoms, cognitive impairment is one of the most common and significant aspects of Parkinson's disease, and cognitive deficits such as dysexecutive syndrome and visuospatial disturbances could seriously affect the quality of life, reduce life expectancy, prolong the duration of hospitalization, and therefore increase burdens of caregiver and medical costs. In this review, we have done a retrospective study of the recent related researches on epidemiology, clinical manifestation and diagnosis, genetics, and potential treatment of cognitive deficits in Parkinson's disease, aiming to provide a summary of cognitive impairment in Parkinson's disease and make it easy for clinicians to tackle this challenging issue in their future practice.

  17. Parkinson's Disease and Cognitive Impairment

    PubMed Central

    Tang, Bei-sha

    2016-01-01

    Parkinson's disease (PD) is a progressive neurodegenerative disease primarily characterized by the hallmarks of motor symptoms, such as tremor, bradykinesia, rigidity, and postural instability. However, through clinical investigations in patients and experimental findings in animal models of Parkinson's disease for years, it is now well recognized that Parkinson's disease is more than just a motor-deficit disorder. The majority of Parkinson's disease patients suffer from nonmotor disabilities, for instance, cognitive impairment, autonomic dysfunction, sensory dysfunction, and sleep disorder. So far, anti-PD prescriptions and surgical treatments have been mainly focusing on motor dysfunctions, leaving cognitive impairment a marginal clinical field. Within the nonmotor symptoms, cognitive impairment is one of the most common and significant aspects of Parkinson's disease, and cognitive deficits such as dysexecutive syndrome and visuospatial disturbances could seriously affect the quality of life, reduce life expectancy, prolong the duration of hospitalization, and therefore increase burdens of caregiver and medical costs. In this review, we have done a retrospective study of the recent related researches on epidemiology, clinical manifestation and diagnosis, genetics, and potential treatment of cognitive deficits in Parkinson's disease, aiming to provide a summary of cognitive impairment in Parkinson's disease and make it easy for clinicians to tackle this challenging issue in their future practice. PMID:28058128

  18. Cancer, cognitive impairment, and meditation.

    PubMed

    Biegler, Kelly A; Chaoul, M Alejandro; Cohen, Lorenzo

    2009-01-01

    Cancer-related cognitive impairment has been acknowledged as a substantial limiting factor in quality of life among cancer patients and survivors. In addition to deficits on behavioral measures, abnormalities in neurologic structure and function have been reported. In this paper, we review findings from the literature on cognitive impairment and cancer, potential interventions, meditation and cognitive function, and meditation and cancer. In addition, we offer our hypotheses on how meditation practice may help to alleviate objective and subjective cognitive function, as well as the advantages of incorporating a meditation program into the treatment of cancer patients and survivors for cancer-related cognitive deficits. Various factors have been hypothesized to play a role in cancer-related cognitive impairment including chemotherapy, reduced hormone levels, proinflammatory immune response, fatigue, and distress. Pharmacotherapies such as methylphenidate or modafinil have been suggested to alleviate cognitive deficits. While initial reports suggest they are effective, some pharmacotherapies have side effects and may not relieve other symptoms associated with multimodal cancer treatment including sleep disturbance, nausea and pain. Several recent studies investigating the effects of meditation programs have reported behavioral and corresponding neurophysiological modulations that may be particularly effective in alleviating cancer-related cognitive impairment. Such programs also have been shown to reduce stress, fatigue, nausea and pain, and improve mood and sleep quality. With the increasing success of cancer treatment and the ability to return to previous family, social, and work activities, symptom management and quality of life are an essential part of survivorship. We propose that meditation may help to improve cancer-related cognitive dysfunction, alleviate other cancer-related sequelae, and should be fully investigated as an adjuvant to cancer treatment.

  19. Cognitive impairments in abstinent alcoholics.

    PubMed Central

    Fein, G; Bachman, L; Fisher, S; Davenport, L

    1990-01-01

    Impaired cognitive functioning in alcoholics is widespread during the first months of detoxification. Between half and two thirds of abstinent alcoholics exhibit cognitive impairments during this period, with residual deficits persisting for years after detoxification in some patients. The most severe deficits have been observed in visuospatial abilities, perceptual-motor integration, abstract reasoning, and new learning. The most significant predictors of cognitive dysfunction in persons recovering from alcoholism are the time elapsed since the last drink and the person's age. Surprisingly, the pattern and duration of a patient's alcohol abuse are relatively weak determinants of neuropsychological impairment during abstinence. Research investigating the hypothesis that cognitive impairments may be related to alcoholic persons resuming drinking has yielded mixed results, but a higher level of neuropsychological functioning is associated with increased rates of completing treatment programs and with greater success in the work environment after discharge from treatment. The possibility of cognitive limitations should be taken into account in planning treatment programs for alcoholism. PMID:2190421

  20. Diabetes mellitus and cognitive impairments

    PubMed Central

    Saedi, Elham; Gheini, Mohammad Reza; Faiz, Firoozeh; Arami, Mohammad Ali

    2016-01-01

    There is strong evidence that diabetes mellitus increases the risk of cognitive impairment and dementia. Insulin signaling dysregulation and small vessel disease in the base of diabetes may be important contributing factors in Alzheimer’s disease and vascular dementia pathogenesis, respectively. Optimal glycemic control in type 1 diabetes and identification of diabetic risk factors and prophylactic approach in type 2 diabetes are very important in the prevention of cognitive complications. In addition, hypoglycemic attacks in children and elderly should be avoided. Anti-diabetic medications especially Insulin may have a role in the management of cognitive dysfunction and dementia but further investigation is needed to validate these findings. PMID:27660698

  1. Cognitive impairment in major depression.

    PubMed

    Marazziti, Donatella; Consoli, Giorgio; Picchetti, Michela; Carlini, Marina; Faravelli, Luca

    2010-01-10

    In the past decade, a growing bulk of evidence has accumulated to suggest that patients suffering from major depression (MD) present some cognitive disturbances, such as impairment in attention, working memory, and executive function, including cognitive inhibition, problem- and task-planning. If the results of short-term memory assessment in depressed patients are equivocal, a general consensus exists that memory problems are secondary to attentional dysfunctions, and reflect the inability to concentrate. Moreover, both unipolar and bipolar patients show evidence of impaired verbal learning that has been commonly interpreted as reflecting an inability to transfer information from short-term to long-term storage. According to some authors, there would be a gender-related as well age-related specificity of some disturbances. Depressed patients also show impairments of executive functions and their recent exploration through brain imaging techniques has recently permitted to formulate some general hypotheses on the possible involvement of different brain areas in MD.

  2. Numerical cognition: Adding it up.

    PubMed

    LeFevre, Jo-Anne

    2016-03-01

    In this article, I provide a historical overview of the field of numerical cognition. I first situate the evolution and development of this field in the more general context of the cognitive revolution, which started in the mid-1950s. I then discuss the genesis of numerical cognition from 6 areas: psychophysics, information processing, neuropsychology, mathematics education, psychometrics, and cognitive development. This history is personal: I discuss some of my own work over the last 30 years and describe how each of the authors of the articles in this collection originally connected with the field. One important goal of the article is to highlight the major findings, both for experts and for those who are less familiar with research on numerical processing. In sum, I sketch a context within which to appreciate the neural, computational, and behavioural work that the other 4 authors summarise in their articles in this special section. (c) 2016 APA, all rights reserved).

  3. Cognitive impairment in substance abuse.

    PubMed

    Vik, Peter W; Cellucci, Tony; Jarchow, Amy; Hedt, Jill

    2004-03-01

    Conventional wisdom, and even well-reasoned theoretical mechanisms, suggests that the chronic use of psychoactive substances would impair cognitive functioning of individuals. This article summarizes the research literature with regard to specific drugs of abuse. Undoubtedly, acute intoxication and immediate and protracted withdrawal produce transient alterations of cognitions that can persist for weeks to months. Some subtle residual effects remain for up to 1 year for certain drugs. Evidence of irreversible effects is less clear. Even subtle lingering effects can impact treatment efforts, yet they often go undetected or unaddressed.

  4. Diabetes cognitive impairments and the effect of traditional chinese herbs.

    PubMed

    Xu, Xiaohan; Guo, Leilei; Tian, Guoqing

    2013-01-01

    The problem of cognitive impairment resulting from diabetes is gaining more acceptance and attention. Both type 1 and type 2 diabetes mellitus have been proved to be associated with reduced performance on numerous domains of cognitive function. Although the exact mechanisms of cognitive impairments in diabetes have not been completely understood, hyperglycemia and insulin resistance seem to play significant roles. And other possible risk factors such as hypoglycemia, insulin deficiency, vascular risk factors, hyperactive HPA axis, depression, and altered neurotransmitters will also be examined. In the meanwhile, this review analyzed the role of the active ingredient of Chinese herbal medicine in the treatment of diabetes cognitive impairments.

  5. Diabetes Cognitive Impairments and the Effect of Traditional Chinese Herbs

    PubMed Central

    Guo, Leilei; Tian, Guoqing

    2013-01-01

    The problem of cognitive impairment resulting from diabetes is gaining more acceptance and attention. Both type 1 and type 2 diabetes mellitus have been proved to be associated with reduced performance on numerous domains of cognitive function. Although the exact mechanisms of cognitive impairments in diabetes have not been completely understood, hyperglycemia and insulin resistance seem to play significant roles. And other possible risk factors such as hypoglycemia, insulin deficiency, vascular risk factors, hyperactive HPA axis, depression, and altered neurotransmitters will also be examined. In the meanwhile, this review analyzed the role of the active ingredient of Chinese herbal medicine in the treatment of diabetes cognitive impairments. PMID:24386004

  6. Cognitive Impairment in Multiple Sclerosis

    PubMed Central

    Lovera, Jesus; Kovner, Blake

    2012-01-01

    Cognitive Impairment (CI) is a serious complication of MS, and the domains affected are well established but new affected domains such as theory of mind are still being identified. The evidence that some disease modifying therapies (DMTs) may improve and prevent the development of CI in MS is not solid. Recent studies on the prevalence CI in MS, although not as solid as studies completed prior to DMT introduction, suggest that CI remains a problem even among people on DMTs and even at the very earliest stages of MS. Functional MRI studies and studies using diffusion tractography show that the impact of lesions on cognition depends on the particular cortical networks affected and their plasticity. Cognitive rehabilitation and L-amphetamine appear promising treatments, cholinesterase inhibitors and memantine have failed, and data on Ginkgo and exercise are limited. We need more work to understand and develop treatment for CI in MS. PMID:22791241

  7. Impaired Verb Fluency: A Sign of Mild Cognitive Impairment

    ERIC Educational Resources Information Center

    Ostberg, Per; Fernaeus, Sven-Erik; Hellstrom, Ake; Bogdanovic, Nenad; Wahlund, Lars Olof

    2005-01-01

    We assessed verb fluency vs. noun and letter-based fluency in 199 subjects referred for cognitive complaints including Subjective Cognitive Impairment, Mild Cognitive Impairment, and Alzheimer's disease. ANCOVAs and factor analyses identified verb, noun, and letter-based fluency as distinct tasks. Verb fluency performance in Mild Cognitive…

  8. Impaired Verb Fluency: A Sign of Mild Cognitive Impairment

    ERIC Educational Resources Information Center

    Ostberg, Per; Fernaeus, Sven-Erik; Hellstrom, Ake; Bogdanovic, Nenad; Wahlund, Lars Olof

    2005-01-01

    We assessed verb fluency vs. noun and letter-based fluency in 199 subjects referred for cognitive complaints including Subjective Cognitive Impairment, Mild Cognitive Impairment, and Alzheimer's disease. ANCOVAs and factor analyses identified verb, noun, and letter-based fluency as distinct tasks. Verb fluency performance in Mild Cognitive…

  9. Pharmacotherapy for Vascular Cognitive Impairment.

    PubMed

    Farooq, Muhammad U; Min, Jiangyong; Goshgarian, Christopher; Gorelick, Philip B

    2017-08-07

    Vascular cognitive impairment (VCI) is the second most common type of dementia after Alzheimer's disease (AD). Stroke and cardiovascular risk factors have been linked to both AD and VCI and potentially can affect cognitive function in mid and later life. Various pharmacological agents, including donepezil, galantamine, and memantine, approved for the treatment of AD have shown modest cognitive benefits in patients with vascular dementia (VaD). However, their functional and global benefits have been inconsistent. Donepezil has shown some cognitive benefit in patients with VaD only, and galantamine has shown some benefit in mixed dementia (AD/VaD). The benefits of other drugs such as rivastigmine, memantine, nimodipine, and piracetam are not clear. Some other supplements and herbal therapies, such as citicoline, actovegin, huperzine A, and vinpocetine, have also been studied in patients with VaD, but their beneficial effects are not well established. Non-drug therapies and lifestyle modifications such as diet, exercise, and vascular risk factor control are important in the management of VCI and should not be ignored. However, there is a need for more robust clinical trials focusing on executive function and other cognitive measures and incorporation of newer imaging modalities to provide additional evidence about the utility of these strategies in patients with VCI.

  10. Living Alone With Cognitive Impairment.

    PubMed

    Gibson, Allison K; Richardson, Virginia E

    2017-02-01

    Although most individuals experiencing cognitive impairment (CI) reside with a caregiver, an estimated 800,000 live alone. Such individuals may have an increased risk for injury to self or others through self-neglect as a result of the CI symptoms. While persons living alone with CI have been identified as an important area for needed research, few studies have been able to examine this population due to the challenges of identifying and recruiting study participants. By using the National Health & Aging Trends Study data set, the researchers explored the characteristics to describe this population. The results of this study indicated that the majority of persons living with CI were older, widowed females who were not diagnosed with Alzheimer's or dementia but tested positive on cognitive screening measures. Further, the majority of persons living alone with CI relied on adult children and paid professionals as the primary care providers.

  11. Age-Related Sensory Impairments and Risk of Cognitive Impairment.

    PubMed

    Fischer, Mary E; Cruickshanks, Karen J; Schubert, Carla R; Pinto, Alex A; Carlsson, Cynthia M; Klein, Barbara E K; Klein, Ronald; Tweed, Ted S

    2016-10-01

    To evaluate the associations between sensory impairments and 10-year risk of cognitive impairment. The Epidemiology of Hearing Loss Study (EHLS), a longitudinal, population-based study of aging in the Beaver Dam, Wisconsin community. Baseline examinations were conducted in 1993 and follow-up examinations have been conducted every 5 years. General community. EHLS members without cognitive impairment at EHLS-2 (1998-2000). There were 1,884 participants (mean age 66.7) with complete EHLS-2 sensory data and follow-up information. Cognitive impairment was defined as a Mini-Mental State Examination score of <24 or history of dementia or Alzheimer's disease. Hearing impairment was a pure-tone average of hearing thresholds (0.5, 1, 2, 4 kHz) of >25 dB hearing level in either ear, visual impairment was a Pelli-Robson contrast sensitivity of <1.55 log units in the better eye, and olfactory impairment was a San Diego Odor Identification Test score of <6. Hearing, visual, and olfactory impairment were independently associated with cognitive impairment risk (hearing: hazard ratio (HR) = 1.90, 95% confidence interval (CI) = 1.11-3.26; vision: HR = 2.05, 95% CI = 1.24-3.38; olfaction: HR = 3.92, 95% CI = 2.45-6.26)). Nevertheless, 85% of participants with hearing impairment, 81% with visual impairment, and 76% with olfactory impairment did not develop cognitive impairment during follow-up. The relationship between sensory impairment and cognitive impairment was not unique to one sensory system, suggesting that sensorineural health may be a marker of brain aging. The development of a combined sensorineurocognitive measure may be useful in uncovering mechanisms of healthy brain aging. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  12. Cerebral hemodynamics and cognitive impairment

    PubMed Central

    Festa, J.R.; Cheung, Y.K.; Chen, R.; Pavol, M.A.; Derdeyn, C.P.; Clarke, W.R.; Videen, T.O.; Grubb, R.L.; Adams, H.P.; Powers, W.J.; Lazar, R.M.

    2012-01-01

    Objective: To determine whether unihemispheral hemodynamic failure is independently associated with cognitive impairment among participants in the National Institute of Neurological Disorders and Stroke–sponsored, multicenter, randomized clinical trial, Randomized Evaluation of Carotid Occlusion and Neurocognition (RECON). Methods: Forty-three patients were randomized into RECON after recent symptomatic carotid artery occlusion and asymmetrically increased oxygen extraction fraction (OEF) by PET (OEF ratio >1.13), indicating stage II hemodynamic failure on the side of occlusion. The PET-positive patients were compared with 28 RECON-enrolled patients who met all clinical and radiographic inclusion/exclusion criteria but had no OEF asymmetry. A multivariable regression compared patients with PET OEF >1.13 or ≤1.13, stratifying by TIA vs stroke as the qualifying event. The dependent variable was a composite neurocognitive score derived from averaging age-normalized z scores on a test battery that included global and internal carotid artery (ICA) side-relevant hemisphere-specific tests. Results: There were no differences in demographic, clinical, or radiologic characteristics between the PET-positive and PET-negative patients except for PET OEF asymmetry. The unadjusted average neurocognitive z score was −1.45 for the PET-positive and −1.25 for the PET-negative patients, indicating cognitive impairment in both groups but no difference between them (p = 0.641). After adjustment for age, education, side of occlusion, depression, and previous stroke, there was a significant difference between PET-positive and PET-negative patients among those with TIA as a qualifying event (average z score = −1.41 vs −0.76, p = 0.040). Older age and right ICA side were also significant in this model. Conclusion: Hemodynamic failure is independently associated with cognitive impairment in patients with carotid occlusion. This finding establishes the physiologic parameter upon

  13. Cognitive impairment in COPD: a systematic review*

    PubMed Central

    Torres-Sánchez, Irene; Rodríguez-Alzueta, Elisabeth; Cabrera-Martos, Irene; López-Torres, Isabel; Moreno-Ramírez, Maria Paz; Valenza, Marie Carmen

    2015-01-01

    The objectives of this study were to characterize and clarify the relationships between the various cognitive domains affected in COPD patients and the disease itself, as well as to determine the prevalence of impairment in the various cognitive domains in such patients. To that end, we performed a systematic review using the following databases: PubMed, Scopus, and ScienceDirect. We included articles that provided information on cognitive impairment in COPD patients. The review of the findings of the articles showed a significant relationship between COPD and cognitive impairment. The most widely studied cognitive domains are memory and attention. Verbal memory and learning constitute the second most commonly impaired cognitive domain in patients with COPD. The prevalence of impairment in visuospatial memory and intermediate visual memory is 26.9% and 19.2%, respectively. We found that cognitive impairment is associated with the profile of COPD severity and its comorbidities. The articles reviewed demonstrated that there is considerable impairment of the cognitive domains memory and attention in patients with COPD. Future studies should address impairments in different cognitive domains according to the disease stage in patients with COPD. PMID:25909154

  14. Caregivers of older adults with cognitive impairment.

    PubMed

    DeFries, Erin L; McGuire, Lisa C; Andresen, Elena M; Brumback, Babette A; Anderson, Lynda A

    2009-04-01

    Because of the growing number of caregivers and the awareness of related health and quality-of-life issues, caregiving has emerged as an important public health issue. We examined the characteristics and caregiving experiences of caregivers of people with and without cognitive impairment. Participants (n = 668) were adults who responded to the 2005 North Carolina Behavioral Risk Factor Surveillance System. Caregivers were people who provided regular care to a family member or friend aged 60 years or older either with or without cognitive impairment (ie, memory loss, confusion, or Alzheimer's disease). Demographic characteristics of caregivers of people with cognitive impairment were similar to those of caregivers of people without cognitive impairment. However, compared with caregivers of people without cognitive impairment, caregivers of people with cognitive impairment reported higher levels of disability, were more likely to be paid, and provided care for a longer duration. Care recipients with cognitive impairment were more likely than care recipients without cognitive impairment to be older, have dementia or confusion, and need assistance with memory and learning. State-level caregiving surveillance is vital in assessing and responding to the needs of the growing number of caregivers.

  15. Cognitive impairment: classification and open issues.

    PubMed

    Basso, Cristina; Limongi, Federica; Siviero, Paola; Romanato, Giovanna; Noale, Marianna; Maggi, Stefania; Battistin, Leontino; Crepaldi, Gaetano

    2007-10-01

    Several clinically-defined cognitive impairment syndromes, with differing diagnostic criteria and nomenclature, have been proposed to describe nondisabling symptomatic cognitive deficits. Incidence and prevalence rates vary as a result of different diagnostic criteria and sampling procedures across studies. The incidence rates of cognitive impairment increase with age; but no consistent data have been reported on the association with family history, age, sex, education, Apo E4 genotype, depression, and other traditional risk factors for dementia. Several studies have suggested that most patients with cognitive impairment clinically defined will progress to Alzheimer Disease (AD), but rates of conversion vary widely among studies. This review summarizes existing definitions and related epidemiological data.

  16. Intracranial stenosis in cognitive impairment and dementia.

    PubMed

    Hilal, Saima; Xu, Xin; Ikram, M Kamran; Vrooman, Henri; Venketasubramanian, Narayanaswamy; Chen, Christopher

    2017-06-01

    Intracranial stenosis is a common vascular lesion observed in Asian and other non-Caucasian stroke populations. However, its role in cognitive impairment and dementia has been under-studied. We, therefore, examined the association of intracranial stenosis with cognitive impairment, dementia and their subtypes in a memory clinic case-control study, where all subjects underwent detailed neuropsychological assessment and 3 T neuroimaging including three-dimensional time-of-flight magnetic resonance angiography. Intracranial stenosis was defined as ≥50% narrowing in any of the intracranial arteries. A total of 424 subjects were recruited of whom 97 were classified as no cognitive impairment, 107 as cognitive impairment no dementia, 70 vascular cognitive impairment no dementia, 121 Alzheimer's Disease, and 30 vascular dementia. Intracranial stenosis was associated with dementia (age/gender/education - adjusted odds ratios (OR): 4.73, 95% confidence interval (CI): 1.93-11.60) and vascular cognitive impairment no dementia (OR: 3.98, 95% CI: 1.59-9.93). These associations were independent of cardiovascular risk factors and MRI markers. However, the association with Alzheimer's Disease and vascular dementia became attenuated in the presence of white matter hyperintensities. Intracranial stenosis is associated with vascular cognitive impairment no dementia independent of MRI markers. In Alzheimer's Disease and vascular dementia, this association is mediated by cerebrovascular disease. Future studies focusing on perfusion and functional markers are needed to determine the pathophysiological mechanism(s) linking intracranial stenosis and cognition so as to identify treatment strategies.

  17. Obesity and Hypertriglyceridemia Produce Cognitive Impairment

    PubMed Central

    Farr, Susan A.; Yamada, Kelvin A.; Butterfield, D. Allan; Abdul, H. Mohammad; Xu, Lin; Miller, Nicole E.; Banks, William A.; Morley, John E.

    2008-01-01

    Obesity is associated with cognitive impairments. Long-term mechanisms for this association include consequences of hyperglycemia, dyslipidemia, or other factors comprising metabolic syndrome X. We found that hypertriglyceridemia, the main dyslipidemia of metabolic syndrome X, is in part responsible for the leptin resistance seen in obesity. Here we determined whether triglycerides have an immediate and direct effect on cognition. Obese mice showed impaired acquisition in three different cognitive paradigms: the active avoidance T-maze, the Morris water maze, and a food reward lever press. These impairments were not attributable to differences in foot shock sensitivity, swim speed, swimming distance, or voluntary milk consumption. Impaired cognition in obese mice was improved by selectively lowering triglycerides with gemfibrozil. Injection into the brain of the triglyceride triolein, but not of the free fatty acid palmitate, impaired acquisition in normal body weight mice. Triolein or milk (97% of fats are triglycerides), but not skim milk (no triglycerides), impaired maintenance of the N-methyl-d-aspartate component of the hippocampal long-term synaptic potential. Measures of oxidative stress in whole brain were reduced by gemfibrozil. We conclude that triglycerides mediate cognitive impairment as seen in obesity, possibly by impairing maintenance of the N-methyl-d-aspartate component of hippocampal long-term potentiation, and that lowering triglycerides can reverse the cognitive impairment and improve oxidative stress in the brain. PMID:18276751

  18. Cognitive impairment in multiple system atrophy

    PubMed Central

    Stankovic, Iva; Krismer, Florian; Jesic, Aleksandar; Antonini, Angelo; Benke, Thomas; Brown, Richard G.; Burn, David J.; Holton, Janice L.; Kaufmann, Horacio; Kostic, Vladimir S.; Ling, Helen; Meissner, Wassilios G.; Poewe, Werner; Semnic, Marija; Seppi, Klaus; Takeda, Atsushi; Weintraub, Daniel; Wenning, Gregor K.

    2014-01-01

    Consensus diagnostic criteria for multiple system atrophy consider dementia as a non-supporting feature, despite emerging evidence demonstrating that cognitive impairments are an integral part of the disease. Cognitive disturbances in multiple system atrophy occur across a wide spectrum from mild single domain deficits to impairments in multiple domains and even to frank dementia in some cases. Frontal-executive dysfunction is the most common presentation, while memory and visuospatial functions may also be impaired. Imaging and neuropathological findings support the concept that cognitive impairments in MSA originate from striatofrontal deafferentation with additional contributions from intrinsic cortical degeneration and cerebellar pathology. Based on a comprehensive evidence-based review we here propose future avenues of research that may ultimately lead to diagnostic criteria for cognitive impairment and dementia associated with multiple system atrophy. PMID:24753321

  19. Cognitive Impairments in Alcohol-Dependent Subjects

    PubMed Central

    Bernardin, Florent; Maheut-Bosser, Anne; Paille, François

    2014-01-01

    Chronic excessive alcohol consumption induces cognitive impairments mainly affecting executive functions, episodic memory, and visuospatial capacities related to multiple brain lesions. These cognitive impairments not only determine everyday management of these patients, but also impact on the efficacy of management and may compromise the abstinence prognosis. Maintenance of lasting abstinence is associated with cognitive recovery in these patients, but some impairments may persist and interfere with the good conduct and the efficacy of management. It therefore appears essential to clearly define neuropsychological management designed to identify and evaluate the type and severity of alcohol-related cognitive impairments. It is also essential to develop cognitive remediation therapy so that the patient can fully benefit from the management proposed in addiction medicine units. PMID:25076914

  20. Cognitive impairment and preferences for current health

    PubMed Central

    King, Joseph T; Tsevat, Joel; Roberts, Mark S

    2009-01-01

    Background We assessed preferences for current health using the visual analogue scale (VAS), standard gamble (SG), time trade-off (TTO), and willingness to pay (WTP) in patients with cerebral aneurysms, a population vulnerable to cognitive deficits related to aneurysm bleeding or treatment. Methods We measured VAS, SG, TTO, and WTP values for current health in 165 outpatients with cerebral aneurysms. We assessed cognitive impairment with the Mini Mental State Examination (MMSE; scores < 24 = cognitive impairment). We examined the distributions of preference responses stratified by cognitive status, and the relationship between preferences and cognitive impairment, patient characteristics, and aneurysm history. Results Eleven patients (7%) had MMSE scores < 24. The distribution of preferences responses from patients with cognitive impairment had greater variance (SG, 0.39 vs. 0.21, P = 0.001; TTO, 0.36 vs. 0.24, P = 0.017) and altered morphology (VAS, P = 0.012; SG, P = 0.023) compared to the responses of unimpaired patients. There was good correlation between most preference measures for unimpaired patients (VAS:TTO, rho = 0.19, P = 0.018; SG:TTO, rho = 0.36, P < 0.001; SG:WTP, rho = -0.33, P < 0.001) and a trend towards significance with another pairing (VAS:WTP, rho = 0.16, P = 0.054). In subjects with cognitive impairment, there was a significant correlation only between VAS and TTO scores (rho = 0.76, P = 0.023). Separate regression models showed that cognitive impairment was associated with lower preferences on the VAS (β = -0.12, P = 0.048), SG (β = -0.23, P = 0.002), and TTO (β = -0.17, P = 0.035). Conclusion Cognitive impairment is associated with lower preferences for current health in patients with cerebral aneurysms. Cognitively impaired patients have poor inter-preference test correlations and different response distributions compared to unimpaired patients. PMID:19134191

  1. Cognitive impairment and stroke in elderly patients

    PubMed Central

    Lo Coco, Daniele; Lopez, Gianluca; Corrao, Salvatore

    2016-01-01

    We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer’s disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking) are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the short and long term, and great efforts should be oriented toward a multidisciplinary approach, including quality-of-life assessment and support of caregivers. PMID:27069366

  2. Cognitive impairments in progression of Parkinson's disease.

    PubMed

    Stepkina, D A; Zakharov, V V; Yakhno, N N

    2010-01-01

    A total of 88 patients with progression of Parkinson's disease (PD) were studied. Cognitive impairments (CI) in PD were in most cases progressive in nature, predominantly because of increases in the severity of dysregulatory and neurodynamic disorders, impairments to visuospatial functions, and, in some cases, deficits in nominative speech function. A high frequency of transformation of moderate cognitive impairments to dementia was demonstrated over periods of 2-5 years. Predictors of the progression of CI in PD were identified: elderly age, later onset of disease, and the severity of PD. The greatest rate of progression of CI was seen in patients with initially more severe impairments of regulatory and visuospatial functions.

  3. [Non-pharmacological treatment of cognitive impairment].

    PubMed

    Ramos Cordero, Primitivo; Yubero, Raquel

    2016-06-01

    This article reviews the effect of non-pharmacological therapies in persons with cognitive impairment, especially treatments aimed at brain stimulation and functional maintenance, since both pharmacological and non-pharmacological therapies affecting the cognitive and psychoaffective domains are reviewed in another article in this supplement. The article also discusses the close and reciprocal relationship between cognitive impairment, diet and nutritional status and describes the main nutritional risk factors and protective factors in cognitive decline. Copyright © 2016 Sociedad Española de Geriatría y Gerontología. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Autoimmune autonomic ganglionopathy with reversible cognitive impairment

    PubMed Central

    Gibbons, Christopher H.; Centi, Justin; Vernino, Steven; Freeman, Roy

    2012-01-01

    Background Autoimmune autonomic ganglionopathy (AAG) is a rare disorder of antibody mediated impaired transmission across the autonomic ganglia resulting in severe autonomic failure. Some patients with AAG report cognitive impairment of unclear etiology despite treatment of autonomic symptoms. Objectives To investigate the relationship between orthostatic hypotension, antibody titers and cognitive impairment in patients with AAG. Design Prospective cohort. Setting Academic medical center. Participants Three patients with AAG underwent neuropsychological testing before and after cycles of plasma exchange in both the seated and standing position to determine the effects of orthostatic hypotension and antibody titers on cognition. Main Outcome Measures Patient responses to neuropsychological tests were measured by percent change from baseline in the seated and standing positions pre- and post-plasma exchange to determine the effects of orthostatic hypotension and antibody titers on cognition. Results Orthostatic hypotension and elevated antibody titer were associated independently with neuropsychological impairment (P<0.05), particularly in domains of executive function, sustained attention, and working memory. Cognitive dysfunction improved, even in the seated normotensive position, after plasmapheresis and consequent reduction in antibody levels. Conclusion The data presented in this study demonstrate reversible cognitive impairment is independently associated with both orthostatic hypotension and elevated nicotinic acetylcholine receptor autoantibodies thereby expanding the clinical spectrum of autonomic ganglionopathy and, in so doing, providing an additional treatable cause of cognitive impairment. PMID:22158721

  5. Evaluation and Management of Posttraumatic Cognitive Impairments

    PubMed Central

    Arciniegas, David B.; Frey, Kimberly L.; Newman, Jody; Wortzel, Hal S.

    2011-01-01

    Psychiatrists are increasingly called upon to care for individuals with cognitive, emotional, and behavioral disturbances after TBI, especially in settings serving military service personnel and Veterans. In both the early and late post-injury periods, cognitive impairments contribute to disability among persons with TBI and are potentially substantial sources of suffering for persons with TBI and their families. In this article, the differential diagnosis, evaluation, and management of posttraumatic cognitive complaints is reviewed. The importance of pre-treatment evaluation as well as consideration of non-cognitive contributors to cognitive problems and functional limitations is emphasized first. The course of recovery after TBI, framed as a progression through posttraumatic encephalopathy, is reviewed next and used to anchor the evaluation and treatment of posttraumatic cognitive impairments in relation to injury severity as well as time post-injury. Finally, pharmacologic and rehabilitative interventions that may facilitate cognitive and functional recovery at each stage of posttraumatic encephalopathy are presented. PMID:21270968

  6. Nutritional status and cognitive impairment in elderly.

    PubMed

    Daradkeh, Ghazi; Essa, Musthafa M; Al-Adawi, S Samir; Koshy, Roopa P; Al-Asmi, Abdullah; Waly, Mostafa I

    2014-10-01

    The elderly population is increasing worldwide and it has been suggested that senior citizens will continue to constitute the bulk of the population in many countries. Nutritional status of senior citizens are adversely affected by their frailty, chronic condition and declining cognitive functioning. Conversely, malnourished elderly further deteriorate their frailty, chronic disease and cognitive functioning. The aim of this review article is to recognize the importance of nutritional assessment of elderly population particularly those with cognitive impairment. First part is to highlight characteristic cognitive impairment among senior citizens and the second one highlight t he background in which malnutrition is a factor that leads to increased risk of morbidity and mortality in the elderly. This review also highlight salgorithms for safeguarding nutritional status among senior citizen and focuses on importance of nutritional screening, assessment and early intervention for safeguarding further deterioration of elderly who are likely to prone to cognitive impairment.

  7. Measuring and managing cognitive impairment in HIV.

    PubMed

    Nightingale, Sam; Winston, Alan

    2017-06-01

    : Cognitive impairment remains a frequently reported complaint in HIV-positive patients despite virologically suppressive antiretroviral therapy. Rates of cognitive impairment in antiretroviral treated HIV-positive cohorts vary and strongly depend on definitions utilized.The underlying pathogenesis is likely to be multifactorial and includes immune activation, neuroinflammation, antiretroviral neurotoxicity, the presence of noninfectious comorbidities such as vascular disease and depression and patient lifestyle factors such as recreational drug use.Contributing factors to cognitive impairment may change over time with ageing HIV-positive populations. Cerebrovascular disease and neurodegenerative causes of cognitive impairment may become more common with advancing age; how these factors interact with HIV-associated cognitive impairment is not yet known.Cerebrospinal fluid HIV RNA escape may occur in up to 10% of patients undergoing lumbar puncture clinically and can be associated with compartmentalized and resistant virus.Changes in antiretroviral therapy in patients with cognitive impairment should be based on current and historic resistance profiles of cerebrospinal fluid and plasma virus, or on potential antiretroviral drug neurotoxicity. Whether and how antiretroviral therapy should be changed in the absence of these factors is not known and requires study in adequately powered randomized trials in carefully selected clinical cohorts.

  8. Impaired Pain Processing Correlates with Cognitive Impairment in Parkinson's Disease

    PubMed Central

    Okada, Akinori; Nakamura, Tomohiko; Suzuki, Junichiro; Suzuki, Masashi; Hirayama, Masaaki; Katsuno, Masahisa; Sobue, Gen

    2016-01-01

    Objective Pain and cognitive impairment are important clinical features in patients with Parkinson's disease (PD). Although pain processing is associated with the limbic system, which is also closely linked to the cognitive function, the association between pain and cognitive impairment in PD is still not well understood. The aim of the study was to investigate the association between pain processing and cognitive impairment in patients with PD. Methods Forty-three patients with PD and 22 healthy subjects were studied. Pain-related somatosensory evoked potentials (SEPs) were generated using a thin needle electrode to stimulate epidermal Aδ fibers. Cognitive impairment was evaluated using the Mini-Mental State Examination (MMSE), the Frontal Assessment Battery, and Japanese version of the Montreal Cognitive Assessment (MoCA-J), and their correlation with pain-related SEPs was investigated. Results The N1/P1 amplitude was significantly lower in PD patients than the controls. N1/P1 peak-to-peak amplitudes correlated with the MMSE (r=0.66, p<0.001) and MoCA-J scores (r=0.38, p<0.01) in patients with PD. These amplitudes also strongly correlated with the domains of attention and memory in the MMSE (attention, r=0.52, p<0.001; memory, r=0.40, p<0.01) and MoCA-J (attention, r=0.45, p<0.005; memory, r=0.48, p<0.001), but not in control subjects. Conclusion A good correlation was observed between the decreased amplitudes of pain-related SEPs and an impairment of attention and memory in patients with PD. Our results suggest that pathological abnormalities of the pain pathway are significantly linked to cognitive impairment in PD. PMID:27803403

  9. Computer Assessment of Mild Cognitive Impairment

    PubMed Central

    Saxton, Judith; Morrow, Lisa; Eschman, Amy; Archer, Gretchen; Luther, James; Zuccolotto, Anthony

    2009-01-01

    Many older individuals experience cognitive decline with aging. The causes of cognitive dysfunction range from the devastating effects of Alzheimer’s disease (AD) to treatable causes of dysfunction and the normal mild forgetfulness described by many older individuals. Even mild cognitive dysfunction can impact medication adherence, impair decision making, and affect the ability to drive or work. However, primary care physicians do not routinely screen for cognitive difficulties and many older patients do not report cognitive problems. Identifying cognitive impairment at an office visit would permit earlier referral for diagnostic work-up and treatment. The Computer Assessment of Mild Cognitive Impairment (CAMCI) is a self-administered, user-friendly computer test that scores automatically and can be completed independently in a quiet space, such as a doctor’s examination room. The goal of this study was to compare the sensitivity and specificity of the CAMCI and the Mini Mental State Examination (MMSE) to identify mild cognitive impairment (MCI) in 524 nondemented individuals > 60 years old who completed a comprehensive neuropsychological and clinical assessment together with the CAMCI and MMSE. We hypothesized that the CAMCI would exhibit good sensitivity and specificity and would be superior compared with the MMSE in these measures. The results indicated that the MMSE was relatively insensitive to MCI. In contrast, the CAMCI was highly sensitive (86%) and specific (94%) for the identification of MCI in a population of community-dwelling nondemented elderly individuals. PMID:19332976

  10. Cognitive Impairment Following Traumatic Brain Injury.

    PubMed

    Arciniegas, David B.; Held, Kerri; Wagner, Peter

    2002-01-01

    Cognitive impairments due to traumatic brain injury (TBI) are substantial sources of morbidity for affected individuals, their family members, and society. Disturbances of attention, memory, and executive functioning are the most common neurocognitive consequences of TBI at all levels of severity. Disturbances of attention and memory are particularly problematic, as disruption of these relatively basic cognitive functions may cause or exacerbate additional disturbances in executive function, communication, and other relatively more complex cognitive functions. Because of the high rate of other physical, neurologic, and psychiatric syndromes following TBI, a thorough neuropsychiatric assessment of the patient is a prerequisite to the prescription of any treatment for impaired cognition. Psychostimulants and other dopaminergically active agents (eg, methylphenidate, dextroamphetamine, amantadine, levodopa/carbidopa, bromocriptine) may modestly improve arousal and speed of information processing, reduce distractibility, and improve some aspects of executive function. Cautious dosing (start-low and go-slow), frequent standardized assessment of effects and side effects, and monitoring for drug-drug interactions are recommended. Cognitive rehabilitation is useful for the treatment of memory impairments following TBI. Cognitive rehabilitation may also be useful for the treatment of impaired attention, interpersonal communication skills, and executive function following TBI. This form of treatment is most useful for patients with mild to moderate cognitive impairments, and may be particularly useful for those who are still relatively functionally independent and motivated to engage in and rehearse these strategies. Psychotherapy (eg, supportive, individual, cognitive-behavioral, group, and family) is an important component of treatment. For patients with medication- and rehabilitation-refractory cognitive impairments, psychotherapy may be needed to assist both patients and

  11. Cognitive Impairment and Progression of CKD.

    PubMed

    Kurella Tamura, Manjula; Yaffe, Kristine; Hsu, Chi-Yuan; Yang, Jingrong; Sozio, Stephen; Fischer, Michael; Chen, Jing; Ojo, Akinlolu; DeLuca, Jennifer; Xie, Dawei; Vittinghoff, Eric; Go, Alan S

    2016-07-01

    Cognitive impairment is common among patients with chronic kidney disease (CKD); however, its prognostic significance is unclear. We assessed the independent association between cognitive impairment and CKD progression in adults with mild to moderate CKD. Prospective cohort. Adults with CKD participating in the CRIC (Chronic Renal Insufficiency Cohort) Study. Mean age of the sample was 57.7±11.0 years and mean estimated glomerular filtration rate (eGFR) was 45.0±16.9mL/min/1.73m(2). Cognitive function was assessed with the Modified Mini-Mental State Examination at study entry. A subset of participants 55 years and older underwent 5 additional cognitive tests assessing different domains. Cognitive impairment was defined as a score > 1 SD below the mean score on each test. Covariates included demographics, kidney function, comorbid conditions, and medications. Incident end-stage renal disease (ESRD) and incident ESRD or 50% decline in baseline eGFR. In 3,883 CRIC participants, 524 (13.5%) had cognitive impairment at baseline. During a median 6.1 years of follow-up, 813 developed ESRD and 1,062 developed ESRD or a ≥50% reduction in eGFR. There was no significant association between cognitive impairment and risk for ESRD (HR, 1.07; 95% CI, 0.87-1.30) or the composite of ESRD or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.89-1.27). Similarly, there was no association between cognitive impairment and the joint outcome of death, ESRD, or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.91-1.23). Among CRIC participants who underwent additional cognitive testing, we found no consistent association between impairment in specific cognitive domains and risk for CKD progression in adjusted analyses. Unmeasured potential confounders, single measure of cognition for younger participants. Among adults with CKD, cognitive impairment is not associated with excess risk for CKD progression after accounting for traditional risk factors. Published by Elsevier Inc.

  12. Frailty and the risk of cognitive impairment.

    PubMed

    Searle, Samuel D; Rockwood, Kenneth

    2015-01-01

    Aging occurs as a series of small steps, first causing cellular damage and then affecting tissues and organs. This is also true in the brain. Frailty, a state of increased risk due to accelerated deficit accumulation, is robustly a risk factor for cognitive impairment. Community-based autopsy studies show that frail individuals have brains that show multiple deficits without necessarily demonstrating cognitive impairment. These facts cast a new light on the growing number of risk factors for cognitive impairment, suggesting that, on a population basis, most health deficits can be associated with late-life cognitive impairment. The systems mechanism by which things that are bad for the body are likely to be bad for the brain can be understood like this: the burden of health deficits anywhere indicates impaired ability to withstand or repair endogenous and environmental damage. This in turn makes additional damage more likely. If true, this suggests that a life course approach to preventing cognitive impairment is desirable. Furthermore, conducting studies in highly selected, younger, healthier individuals to provide 'proof of concept' information is now common. This strategy might exclude the very circumstances that are required for disease expression in the people in whom dementia chiefly occurs (that is, older adults who are often in poor health).

  13. Cognitive impairment after sudden cardiac arrest

    PubMed Central

    Jaszke-Psonka, Magdalena; Piegza, Magdalena; Pudlo, Robert; Piegza, Jacek; Badura-Brzoza, Karina; Leksowska, Aleksandra; Hese, Robert T.; Gorczyca, Piotr W.

    2016-01-01

    Aim To evaluate the incidence and severity of the impairment of selected cognitive functions in patients after sudden cardiac arrest (SCA) in comparison to patients after myocardial infarction without SCA and healthy subjects and to analyze the influence of sociodemographic and clinical parameters and the duration of cardiac arrest on the presence and severity of the described disorders. Material and methods The study group comprised 30 cardiac arrest survivors, the reference group comprised 31 survivors of myocardial infarction without cardiac arrest, and the control group comprised 30 healthy subjects. The Mini-Mental State Examination (MMSE), the Digit Span test from the Wechsler Adult Intelligence Scale, Lauretta Bender’s Visual-Motor Gestalt Test, and the Benton Visual Retention Test (BVRT) were used to assess the presence of cognitive impairment. An original questionnaire developed by the author was used for overall mental state assessment. Results The Bender test demonstrated a significant difference in the presence and severity of visual-motor skills between the study group and the control group, while BVRT and MMSE revealed increased incidence of cognitive impairment in the study group. The Bender and BVRT (D/D)/SS (version D, method D, scaled score) scales indicated cognitive impairment in 53.3% of these patients, while the BVRT (C/A)/SS test indicated cognitive impairment in 40%. For the reference group, the values were 32.3% and 12.9%, respectively. No correlation was found between the severity of cognitive impairment and the duration of cardiac arrest. Conclusions Impairment of visual-motor skills, short-term visual memory, concentration, and visual-motor coordination occurs much more frequently and is more severe in individuals after SCA than in healthy individuals. Impairment of memory trace storage and recall after delay occurs more frequently in patients after SCA than in patients after myocardial infarction without cardiac arrest and in healthy

  14. Vascular cognitive impairment, a cardiovascular complication

    PubMed Central

    Frances, Adiukwu; Sandra, Ofori; Lucy, Ugbomah

    2016-01-01

    Over the past two decades, the term vascular cognitive impairment (VCI) has been used to refer to a spectrum of cognitive decline characterized by executive dysfunction, associated with vascular pathology. With 30% of stroke survivors showing cognitive impairments, it is regarded as the most common cause of cognitive impairment. This is a narrative review of available literature citing sources from PubMed, MEDLINE and Google Scholar. VCI has a high prevalence both before and after a stroke and is associated with great economic and caregiver burden. Despite this, there is no standardized diagnostic criteria for VCI. Hypertension has been identified as a risk factor for VCI and causes changes in cerebral vessel structure and function predisposing to lacuna infarcts and small vessel haemorrhages in the frontostriatal loop leading to executive dysfunction and other cognitive impairments. Current trials have shown promising results in the use of antihypertensive medications in the management of VCI and prevention of disease progression to vascular dementia. Prevention of VCI is necessary in light of the looming dementia pandemic. All patients with cardiovascular risk factors would therefore benefit from cognitive screening with screening instruments sensitive to executive dysfunction as well as prompt and adequate control of hypertension. PMID:27354961

  15. Vascular cognitive impairment, a cardiovascular complication.

    PubMed

    Frances, Adiukwu; Sandra, Ofori; Lucy, Ugbomah

    2016-06-22

    Over the past two decades, the term vascular cognitive impairment (VCI) has been used to refer to a spectrum of cognitive decline characterized by executive dysfunction, associated with vascular pathology. With 30% of stroke survivors showing cognitive impairments, it is regarded as the most common cause of cognitive impairment. This is a narrative review of available literature citing sources from PubMed, MEDLINE and Google Scholar. VCI has a high prevalence both before and after a stroke and is associated with great economic and caregiver burden. Despite this, there is no standardized diagnostic criteria for VCI. Hypertension has been identified as a risk factor for VCI and causes changes in cerebral vessel structure and function predisposing to lacuna infarcts and small vessel haemorrhages in the frontostriatal loop leading to executive dysfunction and other cognitive impairments. Current trials have shown promising results in the use of antihypertensive medications in the management of VCI and prevention of disease progression to vascular dementia. Prevention of VCI is necessary in light of the looming dementia pandemic. All patients with cardiovascular risk factors would therefore benefit from cognitive screening with screening instruments sensitive to executive dysfunction as well as prompt and adequate control of hypertension.

  16. [Cognitive impairment in patients with Parkinson disease].

    PubMed

    Abe, Nobuhito; Mori, Etsuro

    2012-04-01

    Parkinson disease is a progressive neurodegenerative disorder resulting in motor symptoms and cognitive deficits. Neuropsychological studies have suggested that patients with Parkinson disease exhibit a broad range of cognitive deficits even in the early stages of the disease. In this review, we discuss the neuropsychological evidence for cognitive impairment in patients with Parkinson disease, outlining the different domains of cognitive disturbance. First, we review previous findings on executive dysfunction, which is associated with a disruption in frontostriatal circuitry mainly driven by dopaminergic dysmodulation. Executive dysfunction is the core symptom in the cognitive deficits in Parkinson disease. Second, we focus on impairment in different domains of memory function, such as short-term and long-term memory. Third, we discuss the pattern of cognitive deficits in visuospatial ability, ranging from basic perceptual processes to rather complex motor skills. Next, we summarize the profile of cognitive deficits in language, although previous findings are mixed and hence this topic is relatively controversial. Finally, we introduce several recent findings on social cognitive deficits, which is a new area of research that has emerged in the past decade. We also discuss the possible neural mechanisms underlying each domain of cognitive deficits in patients with Parkinson disease.

  17. Asymptomatic carotid stenosis is associated with cognitive impairment.

    PubMed

    Lal, Brajesh K; Dux, Moira C; Sikdar, Siddhartha; Goldstein, Carly; Khan, Amir A; Yokemick, John; Zhao, Limin

    2017-10-01

    Cerebrovascular risk factors (eg, hypertension, coronary artery disease) and stroke can lead to vascular cognitive impairment. The Asymptomatic Carotid Stenosis and Cognitive Function study evaluated the isolated impact of asymptomatic carotid stenosis (no prior ipsilateral or contralateral stroke or transient ischemic attack) on cognitive function. Cerebrovascular hemodynamic and carotid plaque characteristics were analyzed to elucidate potential mechanisms affecting cognition. There were 82 patients with ≥50% asymptomatic carotid stenosis and 62 controls without stenosis but matched for vascular comorbidities who underwent neurologic, National Institutes of Health Stroke Scale, and comprehensive neuropsychological examination. Overall cognitive function and five domain-specific scores were computed. Duplex ultrasound with Doppler waveform and B-mode imaging defined the degree of stenosis, least luminal diameter, plaque area, and plaque gray-scale median. Breath-holding index (BHI) and microembolization were measured using transcranial Doppler. We assessed cognitive differences between stenosis patients and control patients and of stenosis patients with low vs high BHI and correlated cognitive function with microembolic counts and plaque characteristics. Stenosis and control patients did not differ in vascular risk factors, education, estimated intelligence, or depressive symptoms. Stenosis patients had worse composite cognitive scores (P = .02; Cohen's d = 0.43) and domain-specific scores for learning/memory (P = .02; d = 0.42) and motor/processing speed (P = .01; d = 0.65), whereas scores for executive function were numerically lower (P = .08). Approximately 49.4% of all stenosis patients were impaired in at least two cognitive domains. Precisely 50% of stenosis patients demonstrated a reduced BHI. Stenosis patients with reduced BHI performed worse on the overall composite cognitive score (t = -2.1; P = .02; d = 0.53) and tests for learning

  18. Sexual Behavior Among Persons With Cognitive Impairments.

    PubMed

    Thom, Robyn P; Grudzinskas, Albert J; Saleh, Fabian M

    2017-05-01

    Although the cognitively impaired are frequently included in heterogeneous studies of problematic sexual behavior, the epidemiology, etiology, and approach to assessment and treatment of persons with dementia and intellectual disability are distinct from those of the general population. The incidence of inappropriate sexual behavior among the intellectually disabled is 15-33%; however, the nature tends to be more socially inappropriate than with violative intent. Limited sociosexual education is a large contributor, and better addressing this area offers a target for prevention and treatment. A thorough clinical assessment of problematic sexual behaviors in the cognitively impaired requires understanding the patient's internal experience, which can be challenging. Assessment tools validated for the general population have not been validated for this population. Very few studies have assessed treatment approaches specifically among the cognitively impaired; however, research does suggest utility in habilitative, psychotherapeutic, and pharmacologic approaches which have been validated among the general population.

  19. [Functional impairment associated with cognitive impairment in hospitalised elderly].

    PubMed

    Ocampo-Chaparro, José Mauricio; Mosquera-Jiménez, José Ignacio; Davis, Annabelle S; Reyes-Ortiz, Carlos A

    2017-06-24

    The aim of this study was to analyse the effect of cognitive impairment on functional decline in hospitalised patients aged ≥60 years. Measurements at admission included demographic data, Charlson's comorbidity index, and cognitive impairment (according to education level). Data were also collected on hospital length of stay, depression, and delirium developed during hospitalisation. The outcome, Barthel Index (BI), was measured at admission, discharge, and 1-month post-discharge. Patients with BI≤75 at admission (n=54) or with a missing BI value were excluded (n=1). Multivariate logistic regression analyses were conducted to explore predictive factors with functional decline (BI≤75) from admission to discharge, and 1-month later. Of the 133 patients included, 24.8% and 19.6% had a BI≤75 at discharge and at 1-month, respectively. Compared with men, women had more than double risk for functional decline at discharge and 1-month (P<.05). Compared with those without delirium and without cognitive impairment, those with delirium and cognitive impairment had an increased risk for functional decline (BI≤75) at discharge (OR 5.15, 95% CI; 1.94-13.67), and at 1-month (OR 6.26, 95% CI; 2.30-17.03). Similarly, those with comorbidity (≥2) had increased functional decline at discharge (OR 2.36, 95% CI; 1.14-4.87), and at 1-month after discharge (OR 2.71, 95% CI; 1.25-5.89). Delirium during hospitalisation, together with cognitive impairment on admission, was a strong predictor of functional decline. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Perspectives on depression, mild cognitive impairment, and cognitive decline.

    PubMed

    Steffens, David C; Otey, Emeline; Alexopoulos, George S; Butters, Meryl A; Cuthbert, Bruce; Ganguli, Mary; Geda, Yonas E; Hendrie, Hugh C; Krishnan, Ranga R; Kumar, Anand; Lopez, Oscar L; Lyketsos, Constantine G; Mast, Benjamin T; Morris, John C; Norton, Maria C; Peavy, Guerry M; Petersen, Ronald C; Reynolds, Charles F; Salloway, Stephen; Welsh-Bohmer, Kathleen A; Yesavage, Jerome

    2006-02-01

    The public health implications of depression and cognitive impairment in late life are enormous. Cognitive impairment and late-life depression are associated with increased risk for subsequent dementia; however, investigations of these phenomena appear to be proceeding along separate tracks. OBJECTIVES AND DATA SOURCE: The National Institute of Mental Health organized the conference "Perspectives on Depression, Mild Cognitive Impairment, and Cognitive Decline" to consider how the varied perspectives might be better integrated to examine the associations among depression, mild cognitive impairment, and cognitive decline and to illuminate the common or distinct mechanisms involved in these associations. The following 2 broad questions were addressed: (1) What gaps in our knowledge have the greatest public health significance? (2) Can we more efficiently use our research dollars and participant resources to fill these gaps? Meeting participants included grantees from the National Institute of Mental Health and the National Institute on Aging and program staff from the National Institute of Mental Health, the National Institute on Aging, and the National Institute of Neurological Disorders and Stroke. One of the most important recommendations to emerge from the meeting discussions is for increased collaboration among clinical and epidemiological investigators whose work focuses in the area of depression with those working primarily in the area of memory disorders. Directions for future research were identified.

  1. Treatment of Post-Traumatic Cognitive Impairments

    PubMed Central

    Wortzel, Hal S.; Arciniegas, David B.

    2012-01-01

    Opinion statement Cognitive impairment is a common consequence of traumatic brain injury (TBI) and a substantial source of disability. Across all levels of TBI severity, attention, processing speed, episodic memory, and executive function are most commonly affected.The differential diagnosis for posttraumatic cognitive impairments is broad, and includes emotional, behavioral, and physical problems as well as substance use disorders, medical conditions, prescribed and self-administered medications, and symptom elaboration. Thorough neuropsychiatric assessment for such problems is a pre-requisite to treatments specifically targeting cognitive impairments.First-line treatments for posttraumatic cognitive impairments are non-pharmacologic, including education, realistic expectation setting, environmental and lifestyle modifications, and cognitive rehabilitation.Pharmacotherapies for posttraumatic cognitive impairments include uncompetitive N-methyl-D-aspartate receptor (NMDA) antagonists, medications that directly or indirectly augment cerebral catecholaminergic or acetylcholinergic function, or agents with combinations of these properties.In the immediate post-injury period, treatment with uncompetitive NMDA receptor antagonists reduces duration of unconsciousness. The mechanism for this effect may involve attenuation of neurotrauma-induced glutamate-mediated excitotoxicity and/or stabilization of glutamate signaling in the injured brain.During the sub-acute or late post-injury periods, medications that augment cerebral acetylcholinergic function may improve declarative memory. Among responders to this treatment, secondary benefits on attention, processing speed, and executive function impairments as well as neuropsychiatric disturbances may be observed. During these post-injury periods, medications that augment cerebral catecholaminergic function may improve hypoarousal, processing speed, attention, and/or executive function as well as comorbid depression or apathy

  2. Screening for Cognitive Impairments in Primary Blepharospasm

    PubMed Central

    Yang, Jing; Song, Wei; Wei, Qianqian; Ou, Ruwei; Cao, Bei; Liu, Wanglin; Shao, Na; Shang, Hui-Fang

    2016-01-01

    Backgrounds Studies have reported that non-motor symptoms are an important component of primary dystonia. However, evidence supporting cognitive impairment in primary dystonia is limited and contradictory. Methods We applied the Chinese version of the Addenbrooke’s Cognitive Examination-Revised and the Mini-Mental State Examination (MMSE) to screen for cognitive impairment in patients with primary blepharospasm. In addition, we investigated the relationship between performance on the Addenbrooke’s Cognitive Examination-Revised and quality of life as measured by the Medical Outcomes Study 36-item Short-Form (SF36). Results The study included 68 primary blepharospasm patients and 68 controls matched by age, sex and education. The prevalence of cognitive deficits was 22.0% and 32.3% in primary blepharospasm patients group, as measured by the MMSE and the Addenbrooke’s Cognitive Examination-Revised, respectively. Primary blepharospasm patents had a broad range of cognitive deficits, with the most frequently affected domains being visuospatial function (30.9%) and language (30.9%), followed by memory (27.9%), orientation/attention (26.4%) and verbal fluency (22.0%). Patients with cognitive deficits had lower total SF36 scores, especially in the subdomains of physical functioning, role-physical and social functioning, compared to those without cognitive deficits. Scores on the Addenbrooke’s Cognitive Examination-Revised were significantly correlated with both the SF36 scores and the scores on the subdomains of physical functioning and social functioning. Conclusions Some patients with primary blepharospasm have cognitive deficits. Poor performance on the Addenbrooke’s Cognitive Examination-Revised is related to poorer quality of life. PMID:27526026

  3. THE OLDER ADULT DRIVER WITH COGNITIVE IMPAIRMENT

    PubMed Central

    Carr, David B.; Ott, Brian R.

    2010-01-01

    Although automobiles remain the transportation of choice for older adults, late life cognitive impairment and dementia often impair the ability to drive safely. There is, however, no commonly utilized method of assessing dementia severity in relation to driving, no consensus on the assessment of older drivers with cognitive impairment, and no gold standard for determining driving fitness. Yet, clinicians are called upon by patients, their families, other health professionals, and often the Department of Motor Vehicles (DMV) to assess their patients' fitness-to-drive and to make recommendations about driving privileges. Using the case of Mr W, we describe the challenges of driving with cognitive impairment for both the patient and caregiver, summarize the literature on dementia and driving, discuss evidenced-based assessment of fitness-to-drive, and address important ethical and legal issues. We describe the role of physician assessment, referral to neuropsychology, functional screens, dementia severity tools, driving evaluation clinics, and DMV referrals that may assist with evaluation. Finally, we discuss mobility counseling (eg, exploration of transportation alternatives) since health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance our patients' social connectedness and quality of life, while meeting their psychological and medical needs and maintaining personal and public safety. PMID:20424254

  4. Basic Mechanisms Underlying Postchemotherapy Cognitive Impairment

    DTIC Science & Technology

    2010-04-01

    hippocampus is involved in a number of important functions, including memory formation and retrieval, learning, and neuroendocrine and mood regulation...cognitive deficits in humans; however, the mechanism is not known. Neurogenesis, the formation of new nerve cells, occurs throughout adulthood and is...these agents produce cognitive impairment by disrupting neurogenesis in the hippocampus . The experiments in this Concept grant began to develop and

  5. Stroke injury, cognitive impairment and vascular dementia☆

    PubMed Central

    Kalaria, Raj N.; Akinyemi, Rufus; Ihara, Masafumi

    2016-01-01

    The global burden of ischaemic strokes is almost 4-fold greater than haemorrhagic strokes. Current evidence suggests that 25–30% of ischaemic stroke survivors develop immediate or delayed vascular cognitive impairment (VCI) or vascular dementia (VaD). Dementia after stroke injury may encompass all types of cognitive disorders. States of cognitive dysfunction before the index stroke are described under the umbrella of pre-stroke dementia, which may entail vascular changes as well as insidious neurodegenerative processes. Risk factors for cognitive impairment and dementia after stroke are multifactorial including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischaemic attack or recurrent stroke and depressive illness. Neuroimaging determinants of dementia after stroke comprise silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Until recently, the neuropathology of dementia after stroke was poorly defined. Most of post-stroke dementia is consistent with VaD involving multiple substrates. Microinfarction, microvascular changes related to blood–brain barrier damage, focal neuronal atrophy and low burden of co-existing neurodegenerative pathology appear key substrates of dementia after stroke injury. The elucidation of mechanisms of dementia after stroke injury will enable establishment of effective strategy for symptomatic relief and prevention. Controlling vascular disease risk factors is essential to reduce the burden of cognitive dysfunction after stroke. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock. PMID:26806700

  6. Vascular aspects of cognitive impairment and dementia

    PubMed Central

    Wiesmann, Maximilian; Kiliaan, Amanda J; Claassen, Jurgen AHR

    2013-01-01

    Hypertension and stroke are highly prevalent risk factors for cognitive impairment and dementia. Alzheimer's disease (AD) and vascular dementia (VaD) are the most common forms of dementia, and both conditions are preceded by a stage of cognitive impairment. Stroke is a major risk factor for the development of vascular cognitive impairment (VCI) and VaD; however, stroke may also predispose to AD. Hypertension is a major risk factor for stroke, thus linking hypertension to VCI and VaD, but hypertension is also an important risk factor for AD. Reducing these two major, but modifiable, risk factors—hypertension and stroke—could be a successful strategy for reducing the public health burden of cognitive impairment and dementia. Intake of long-chain omega-3 polyunsaturated fatty acids (LC-n3-FA) and the manipulation of factors involved in the renin–angiotensin system (e.g. angiotensin II or angiotensin-converting enzyme) have been shown to reduce the risk of developing hypertension and stroke, thereby reducing dementia risk. This paper will review the research conducted on the relationship between hypertension, stroke, and dementia and also on the impact of LC-n3-FA or antihypertensive treatments on risk factors for VCI, VaD, and AD. PMID:24022624

  7. Piracetam treatment in patients with cognitive impairment.

    PubMed

    Rao, Mukund G; Holla, Bharath; Varambally, Shivarama; Raveendranathan, Dhanya; Venkatasubramanian, Ganesan; Gangadhar, Bangalore N

    2013-01-01

    Piracetam is a cognitive-enhancing agent that is used for the treatment of cognitive impairments of various etiologies. Little is known about its side effect profile, especially in those with psychiatric illness. We herewith present two cases with cognitive impairment who had contrasting responses to piracetam. One of them with organic amnestic syndrome had significant improvement, whereas the other who had an organic personality change as well as a family history of mental illness had significant worsening of behavioral problems after piracetam was introduced. This report highlights the need for caution in the use of piracetam, especially in those with past or family history of psychiatric illness. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Cognitive impairment in obstructive sleep apnea.

    PubMed

    Gagnon, K; Baril, A-A; Gagnon, J-F; Fortin, M; Décary, A; Lafond, C; Desautels, A; Montplaisir, J; Gosselin, N

    2014-10-01

    Obstructive sleep apnea (OSA) is characterised by repetitive cessation or reduction of airflow due to upper airway obstructions. These respiratory events lead to chronic sleep fragmentation and intermittent hypoxemia. Several studies have shown that OSA is associated with daytime sleepiness and cognitive dysfunctions, characterized by impairments of attention, episodic memory, working memory, and executive functions. This paper reviews the cognitive profile of adults with OSA and discusses the relative role of altered sleep and hypoxemia in the aetiology of these cognitive deficits. Markers of cognitive dysfunctions such as those measured with waking electroencephalography and neuroimaging are also presented. The effects of continuous positive airway pressure (CPAP) on cognitive functioning and the possibility of permanent brain damage associated with OSA are also discussed. Finally, this paper reviews the evidence suggesting that OSA is a risk factor for developing mild cognitive impairment and dementia in the aging population and stresses the importance of its early diagnosis and treatment. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  9. Diagnostic transitions in mild cognitive impairment subtypes.

    PubMed

    Forlenza, Orestes Vicente; Diniz, Breno Satler; Nunes, Paula Villela; Memória, Claudia Maia; Yassuda, Monica Sanches; Gattaz, Wagner Farid

    2009-12-01

    At least for a subset of patients, the clinical diagnosis of mild cognitive impairment (MCI) may represent an intermediate stage between normal aging and dementia. Nevertheless, the patterns of transition of cognitive states between normal cognitive aging and MCI to dementia are not well established. In this study we address the pattern of transitions between cognitive states in patients with MCI and healthy controls, prior to the conversion to dementia. 139 subjects (78% women, mean age, 68.5 +/- 6.1 years; mean educational level, 11.7 +/- 5.4 years) were consecutively assessed in a memory clinic with a standardized clinical and neuropsychological protocol, and classified as cognitively healthy (normal controls) or with MCI (including subtypes) at baseline. These subjects underwent annual reassessments (mean duration of follow-up: 2.7 +/- 1.1 years), in which cognitive state was ascertained independently of prior diagnoses. The pattern of transitions of the cognitive state was determined by Markov chain analysis. The transitions from one cognitive state to another varied substantially between MCI subtypes. Single-domain MCI (amnestic and non-amnestic) more frequently returned to normal cognitive state upon follow-up (22.5% and 21%, respectively). Among subjects who progressed to Alzheimer's disease (AD), the most common diagnosis immediately prior conversion was multiple-domain MCI (85%). The clinical diagnosis of MCI and its subtypes yields groups of patients with heterogeneous patterns of transitions between one given cognitive state to another. The presence of more severe and widespread cognitive deficits, as indicated by the group of multiple-domain amnestic MCI may be a better predictor of AD than single-domain amnestic or non-amnestic deficits. These higher-risk individuals could probably be the best candidates for the development of preventive strategies and early treatment for the disease.

  10. Molecular pathways: radiation-induced cognitive impairment.

    PubMed

    Greene-Schloesser, Dana; Moore, Elizabeth; Robbins, Mike E

    2013-05-01

    Each year, approximately 200,000 patients in the United States will receive partial- or whole-brain irradiation for the treatment of primary or metastatic brain cancer. Early and delayed radiation effects are transient and reversible with modern therapeutic standards; yet, late radiation effects (≥6 months postirradiation) remain a significant risk, resulting in progressive cognitive impairment. These risks include functional deficits in memory, attention, and executive function that severely affect the patient's quality of life. The mechanisms underlying radiation-induced cognitive impairment remain ill defined. Classically, radiation-induced alterations in vascular and neuroinflammatory glial cell clonogenic populations were hypothesized to be responsible for radiation-induced brain injury. Recently, preclinical studies have focused on the hippocampus, one of two sites of adult neurogenesis within the brain, which plays an important role in learning and memory. Radiation ablates hippocampal neurogenesis, alters neuronal function, and induces neuroinflammation. Neuronal stem cells implanted into the hippocampus prevent the decrease in neurogenesis and improve cognition after irradiation. Clinically prescribed drugs, including PPARα and PPARγ agonists, as well as RAS blockers, prevent radiation-induced neuroinflammation and cognitive impairment independent of improved neurogenesis. Translating these exciting findings to the clinic offers the promise of improving the quality of life of brain tumor patients who receive radiotherapy. ©2013 AACR.

  11. Cognitive impairment, genomic instability and trace elements.

    PubMed

    Meramat, A; Rajab, N F; Shahar, S; Sharif, R

    2015-01-01

    Cognitive impairments are often related to aging and micronutrient deficiencies. Various essential micronutrients in the diet are involved in age-altered biological functions such as, zinc, copper, iron, and selenium that play pivotal roles either in maintaining and reinforcing the antioxidant performances or in affecting the complex network of genes (nutrigenomic approach) involved in encoding proteins for biological functions. Genomic stability is one of the leading causes of cognitive decline and deficiencies or excess in trace elements are two of the factors relating to it. In this review, we report and discuss the role of micronutrients in cognitive impairment in relation to genomic stability in an aging population. Telomere integrity will also be discussed in relation to aging and cognitive impairment, as well as, the micronutrients related to these events. This review will provide an understanding on how these three aspects can relate with each other and why it is important to keep a homeostasis of micronutrients in relation to healthy aging. Micronutrient deficiencies and aging process can lead to genomic instability.

  12. [EEG investigations in cognitive impairments].

    PubMed

    Szirmai, Imre; Kamondi, Anita

    2011-01-30

    The EEG is an indicator of all physiological and neuropsychological activity. The alpha rhythm was considered as a key phenomenon in research of human mentation from the discovery of EEG. Two methods are known for the estimation of cognitive deficit by the use of quantitative EEG (QEEG). The first is based on the hypothesis, that the mean values of the normal EEG from healthy volunteers can be used as reference, and deviation from the normal values of EEG parameters may suggest disease. This kind of "neurometry" was elaborated by R. E. John. The second method assesses event related (ER) transients evoked by somatosensory and mental stimuli. Quantity and localization of signals may refer to the functional state of the cortex. These reactions depend strongly on the test-paradigms. Recognition of the attention-intention cycle disclosed the physiological mechanism of ERD (event related desynchronisation) and ERS (event related synchronisation). In contrast with the classical "stimulus-reaction" model, both perception and voluntary movement are initiated by the brain itself, and not by the environment. Human behavior and conscious actions depend on the intention. QEEG analysis proved that the attention and intention localize in segregate areas of the brain. Both "static" and "dynamic" neurometric methods are able to differentiate the EEG records of demented patients from healthy controls, furthermore some dementias from each other. We conclude that with the help of sophisticated methods of QEEG analysis minimal functional deficit of the electrogenesis can be recognized, which could be helpful in the differential diagnosis Notwithstanding the EEG can not explain the evolution neither the normal or the diseased mental processes. The only "instrument" which is able to approach the human mind is the human cogitation itself with the aids of appropriate tests. The QEEG can be conclusive in the analysis of particular processes of mental activity, such as timing, state of

  13. Cognitive Training in Older Adults with Mild Cognitive Impairment.

    PubMed

    Liu, Xin Yan; Li, Li; Xiao, Jia Qing; He, Chang Zhi; Lyu, Xiu Lin; Gao, Lei; Yang, Xiao Wei; Cui, Xin Gang; Fan, Li Hua

    2016-05-01

    We investigated the feasibility and efficacy of cognitive training for older adults in rural settings and with low education levels, who have mild cognitive impairment (MCI). Forty-five older adults (ages >65 years) with MCI were assigned to treatment or control groups, at a 2:1 ratio. Cognitive training occurred in the treatment group for 2 months. The cognitive abilities of the participants were assessed at pre-training, metaphase, and post-training time points, using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), and Hamilton Depression Scale (HAM-D). Following training, cognitive abilities improved in the treatment group, based on the total scores of all 4 measures, as well as specifically on the MoCA and LOTCA. There were differences in the main effects of group and time point on some subscales, but these differences had little, if any, effect on the overall analyses. The present study demonstrated that cognitive training has beneficial effects on attention, language, orientation, visual perception, organization of visual movement, and logical questioning in patients with MCI. Furthermore, the observed effects are long-term changes. Copyright © 2016 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

  14. Vascular Contributions to Cognitive Impairment and Dementia

    PubMed Central

    Gorelick, Philip B.; Scuteri, Angelo; Black, Sandra E.; DeCarli, Charles; Greenberg, Steven M.; Iadecola, Costantino; Launer, Lenore J.; Laurent, Stephane; Lopez, Oscar L.; Nyenhuis, David; Petersen, Ronald C.; Schneider, Julie A.; Tzourio, Christophe; Arnett, Donna K.; Bennett, David A.; Chui, Helena C.; Higashida, Randall T.; Lindquist, Ruth; Nilsson, Peter M.; Roman, Gustavo C.; Sellke, Frank W.; Seshadri, Sudha

    2013-01-01

    Background and Purpose This scientific statement provides an overview of the evidence on vascular contributions to cognitive impairment and dementia. Vascular contributions to cognitive impairment and dementia of later life are common. Definitions of vascular cognitive impairment (VCI), neuropathology, basic science and pathophysiological aspects, role of neuroimaging and vascular and other associated risk factors, and potential opportunities for prevention and treatment are reviewed. This statement serves as an overall guide for practitioners to gain a better understanding of VCI and dementia, prevention, and treatment. Methods Writing group members were nominated by the writing group co-chairs on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council Scientific Statement Oversight Committee, the Council on Epidemiology and Prevention, and the Manuscript Oversight Committee. The writing group used systematic literature reviews (primarily covering publications from 1990 to May 1, 2010), previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and, when appropriate, formulate recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on the recommendations and approved the final version of this document. After peer review by the American Heart Association, as well as review by the Stroke Council leadership, Council on Epidemiology and Prevention Council, and Scientific Statements Oversight Committee, the statement was approved by the American Heart Association Science Advisory and Coordinating Committee. Results The construct of VCI has been introduced to capture the entire spectrum of cognitive disorders associated with all forms of cerebral vascular brain injury—not solely stroke—ranging from mild cognitive impairment through fully developed

  15. Retinal vascular fractals and cognitive impairment.

    PubMed

    Ong, Yi-Ting; Hilal, Saima; Cheung, Carol Yim-Lui; Xu, Xin; Chen, Christopher; Venketasubramanian, Narayanaswamy; Wong, Tien Yin; Ikram, Mohammad Kamran

    2014-05-01

    Retinal microvascular network changes have been found in patients with age-related brain diseases such as stroke and dementia including Alzheimer's disease. We examine whether retinal microvascular network changes are also present in preclinical stages of dementia. This is a cross-sectional study of 300 Chinese participants (age: ≥60 years) from the ongoing Epidemiology of Dementia in Singapore study who underwent detailed clinical examinations including retinal photography, brain imaging and neuropsychological testing. Retinal vascular parameters were assessed from optic disc-centered photographs using a semiautomated program. A comprehensive neuropsychological battery was administered, and cognitive function was summarized as composite and domain-specific Z-scores. Cognitive impairment no dementia (CIND) and dementia were diagnosed according to standard diagnostic criteria. Among 268 eligible nondemented participants, 78 subjects were categorized as CIND-mild and 69 as CIND-moderate. In multivariable adjusted models, reduced retinal arteriolar and venular fractal dimensions were associated with an increased risk of CIND-mild and CIND-moderate. Reduced fractal dimensions were associated with poorer cognitive performance globally and in the specific domains of verbal memory, visuoconstruction and visuomotor speed. A sparser retinal microvascular network, represented by reduced arteriolar and venular fractal dimensions, was associated with cognitive impairment, suggesting that early microvascular damage may be present in preclinical stages of dementia.

  16. Memory, executive, and multidomain subtle cognitive impairment

    PubMed Central

    Toledo, Jon B.; Bjerke, Maria; Chen, Kewei; Rozycki, Martin; Jack, Clifford R.; Weiner, Michael W.; Arnold, Steven E.; Reiman, Eric M.; Davatzikos, Christos; Shaw, Leslie M.

    2015-01-01

    Objective: We studied the biomarker signatures and prognoses of 3 different subtle cognitive impairment (SCI) groups (executive, memory, and multidomain) as well as the subjective memory complaints (SMC) group. Methods: We studied 522 healthy controls in the Alzheimer's Disease Neuroimaging Initiative (ADNI). Cutoffs for executive, memory, and multidomain SCI were defined using participants who remained cognitively normal (CN) for 7 years. CSF Alzheimer disease (AD) biomarkers, composite and region-of-interest (ROI) MRI, and fluorodeoxyglucose-PET measures were compared in these participants. Results: Using a stringent cutoff (fifth percentile), 27.6% of the ADNI participants were classified as SCI. Most single ROI or global-based measures were not sensitive to detect differences between groups. Only MRI-SPARE-AD (Spatial Pattern of Abnormalities for Recognition of Early AD), a quantitative MRI pattern-based global index, showed differences between all groups, excluding the executive SCI group. Atrophy patterns differed in memory SCI and SMC. The CN and the SMC groups presented a similar distribution of preclinical dementia stages. Fifty percent of the participants with executive, memory, and multidomain SCI progressed to mild cognitive impairment or dementia at 7, 5, and 2 years, respectively. Conclusions: Our results indicate that (1) the different SCI categories have different clinical prognoses and biomarker signatures, (2) longitudinally followed CN subjects are needed to establish clinical cutoffs, (3) subjects with SMC show a frontal pattern of brain atrophy, and (4) pattern-based analyses outperform commonly used single ROI-based neuroimaging biomarkers and are needed to detect initial stages of cognitive impairment. PMID:26085606

  17. Vascular cognitive impairment neuropathology guidelines (VCING): the contribution of cerebrovascular pathology to cognitive impairment.

    PubMed

    Skrobot, Olivia A; Attems, Johannes; Esiri, Margaret; Hortobágyi, Tibor; Ironside, James W; Kalaria, Rajesh N; King, Andrew; Lammie, George A; Mann, David; Neal, James; Ben-Shlomo, Yoav; Kehoe, Patrick G; Love, Seth

    2016-09-02

    There are no generally accepted protocols for post-mortem assessment in cases of suspected vascular cognitive impairment. Neuropathologists from seven UK centres have collaborated in the development of a set of vascular cognitive impairment neuropathology guidelines (VCING), representing a validated consensus approach to the post-mortem assessment and scoring of cerebrovascular disease in relation to vascular cognitive impairment. The development had three stages: (i) agreement on a sampling protocol and scoring criteria, through a series of Delphi method surveys; (ii) determination of inter-rater reliability for each type of pathology in each region sampled (Gwet's AC2 coefficient); and (iii) empirical testing and validation of the criteria, by blinded post-mortem assessment of brain tissue from 113 individuals (55 to 100 years) without significant neurodegenerative disease who had had formal cognitive assessments within 12 months of death. Fourteen different vessel and parenchymal pathologies were assessed in 13 brain regions. Almost perfect agreement (AC2 > 0.8) was found when the agreed criteria were used for assessment of leptomeningeal, cortical and capillary cerebral amyloid angiopathy, large infarcts, lacunar infarcts, microhaemorrhage, larger haemorrhage, fibrinoid necrosis, microaneurysms, perivascular space dilation, perivascular haemosiderin leakage, and myelin loss. There was more variability (but still reasonably good agreement) in assessment of the severity of arteriolosclerosis (0.45-0.91) and microinfarcts (0.52-0.84). Regression analyses were undertaken to identify the best predictors of cognitive impairment. Seven pathologies-leptomeningeal cerebral amyloid angiopathy, large infarcts, lacunar infarcts, microinfarcts, arteriolosclerosis, perivascular space dilation and myelin loss-predicted cognitive impairment. Multivariable logistic regression determined the best predictive models of cognitive impairment. The preferred model included moderate

  18. Development of cognitive screening test for the severely hearing impaired: Hearing-impaired MoCA.

    PubMed

    Lin, Vincent Y W; Chung, Janet; Callahan, Brandy L; Smith, Leah; Gritters, Nils; Chen, Joseph M; Black, Sandra E; Masellis, Mario

    2017-05-01

    To develop a version of the Montreal Cognitive Assessment (MoCA) to be administered to the severely hearing impaired (HI-MoCA), and to assess its performance in two groups of cognitively intact adults over the age of 60. Test development followed by prospective subject recruitment. The MoCA was converted into a timed PowerPoint (Microsoft Corp., Redmond, WA) presentation, and verbal instructions were converted into visual instructions. Two groups of subjects over the age of 60 were recruited. All subjects passed screening questionnaires to eliminate those with undiagnosed mild cognitive impairment. The first group had normal hearing (group 1). The second group was severely hearing impaired (group 2). Group 1 received either the MoCA or HI-MoCA test (T1). Six months later (T2), subjects were administered the test (MoCA or HI-MoCA) they had not received previously to determine equivalency. Group 2 received the HI-MoCA at T1 and again at T2 to determine test-retest reliability. One hundred and three subjects were recruited into group 1, with a score of 26.66 (HI-MoCA) versus 27.14 (MoCA). This was significant (P < 0.05), but scoring uses whole numerals and the 0.48 difference was found not clinically significant using post hoc sensitivity analyses. Forty-nine subjects were recruited into group 2. They scored 26.18 and 26.49 (HI-MoCA at T1 and T2). No significance was noted (P > 0.05), with a test-retest coefficient of 0.66. The HI-MoCA is easy to administer and reliable for screening cognitive impairment in the severely hearing impaired. No conversion factor is required in our prospectively tested cohort of cognitively intact subjects. 1b. Laryngoscope, 127:S4-S11, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  19. Cognitive Impairment Involving Social Cognition in SPG4 Hereditary Spastic Paraplegia

    PubMed Central

    Chamard, Ludivine; Ferreira, Sabrina; Pijoff, Alexa; Silvestre, Manon; Berger, Eric

    2016-01-01

    Objectives. To describe cognitive assessment including social cognition in SPG4 patients. Methods. We reported a series of nine patients with SPG4 mutation with an extensive neuropsychological examination including social cognition assessment. Results. None of our patients presented with mental retardation or dementia. All presented with mild cognitive impairment with a high frequency of attention deficit (100%), executive disorders (89%), and social cognition impairment (78%). An asymptomatic patient for motor skills presented with the same cognitive profile. No correlation was found in this small sample between cognitive impairment and motor impairment, age at disease onset, or disease duration. Conclusions. SPG4 phenotypes share some cognitive features of frontotemporal lobar degeneration and amyotrophic lateral sclerosis. Cognitive disorders including executive disorders and social cognition impairment are frequent in SPG4 patients and might sometimes occur before motor disorders. Therefore, cognitive functions including social cognition should be systematically assessed in order to improve the clinical management of this population. PMID:27688599

  20. Assessment of cognition in mild cognitive impairment: A comparative study

    PubMed Central

    Snyder, Peter J.; Jackson, Colleen E.; Petersen, Ronald C.; Khachaturian, Ara S.; Kaye, Jeffrey; Albert, Marilyn S.; Weintraub, Sandra

    2014-01-01

    The demand for rapidly administered, sensitive, and reliable cognitive assessments that are specifically designed for identifying individuals in the earliest stages of cognitive decline (and to measure subtle change over time) has escalated as the emphasis in Alzheimer’s disease clinical research has shifted from clinical diagnosis and treatment toward the goal of developing presymptomatic neuroprotective therapies. To meet these changing clinical requirements, cognitive measures or tailored batteries of tests must be validated and determined to be fit-for-use for the discrimination between cognitively healthy individuals and persons who are experiencing very subtle cognitive changes that likely signal the emergence of early mild cognitive impairment. We sought to collect and review data systematically from a wide variety of (mostly computer-administered) cognitive measures, all of which are currently marketed or distributed with the claims that these instruments are sensitive and reliable for the early identification of disease or, if untested for this purpose, are promising tools based on other variables. The survey responses for 16 measures/batteries are presented in brief in this review; full survey responses and summary tables are archived and publicly available on the Campaign to Prevent Alzheimer’s Disease by 2020 Web site (http://pad2020.org). A decision tree diagram highlighting critical decision points for selecting measures to meet varying clinical trials requirements has also been provided. Ultimately, the survey questionnaire, framework, and decision guidelines provided in this review should remain as useful aids for the evaluation of any new or updated sets of instruments in the years to come. PMID:21575877

  1. Functional Hubs in Mild Cognitive Impairment

    NASA Astrophysics Data System (ADS)

    Navas, Adrián; Papo, David; Boccaletti, Stefano; Del-Pozo, F.; Bajo, Ricardo; Maestú, Fernando; Martínez, J. H.; Gil, Pablo; Sendiña-Nadal, Irene; Buldú, Javier M.

    We investigate how hubs of functional brain networks are modified as a result of mild cognitive impairment (MCI), a condition causing a slight but noticeable decline in cognitive abilities, which sometimes precedes the onset of Alzheimer's disease. We used magnetoencephalography (MEG) to investigate the functional brain networks of a group of patients suffering from MCI and a control group of healthy subjects, during the execution of a short-term memory task. Couplings between brain sites were evaluated using synchronization likelihood, from which a network of functional interdependencies was constructed and the centrality, i.e. importance, of their nodes was quantified. The results showed that, with respect to healthy controls, MCI patients were associated with decreases and increases in hub centrality respectively in occipital and central scalp regions, supporting the hypothesis that MCI modifies functional brain network topology, leading to more random structures.

  2. Hypersexuality among cognitively impaired older adults.

    PubMed

    Wallace, Meredith; Safer, Meredith

    2009-01-01

    Hypersexuality, also referred to in the literature as sexually inappropriate behavior and sexual disinhibition, involves persistent, uninhibited sexual behaviors directed at oneself or at others. For older adults, the literature generally attributes the behavior to biochemical or physiological changes that accompany cognitive impairment-specifically, dementia. Although less common than other behavioral issues, such as aggression and agitation, hypersexuality presents complex logistical and ethical problems for caregivers. This article reviews the current literature on hypersexual behavior. Assessment essentials as well as nonpharmacological and pharmacological treatment approaches are discussed, identifying the need for standardization as well as caregiver education and training.

  3. Mild cognitive impairment: a concept in evolution.

    PubMed

    Petersen, R C; Caracciolo, B; Brayne, C; Gauthier, S; Jelic, V; Fratiglioni, L

    2014-03-01

    The construct of mild cognitive impairment (MCI) has evolved over the past 10 years since the publication of the new MCI definition at the Key Symposium in 2003, but the core criteria have remained unchanged. The construct has been extensively used worldwide, both in clinical and in research settings, to define the grey area between intact cognitive functioning and clinical dementia. A rich set of data regarding occurrence, risk factors and progression of MCI has been generated. Discrepancies between studies can be mostly explained by differences in the operationalization of the criteria, differences in the setting where the criteria have been applied, selection of subjects and length of follow-up in longitudinal studies. Major controversial issues that remain to be further explored are algorithmic versus clinical classification, reliability of clinical judgment, temporal changes in cognitive performances and predictivity of putative biomarkers. Some suggestions to further develop the MCI construct include the tailoring of the clinical criteria to specific populations and to specific contexts. The addition of biomarkers to the clinical phenotypes is promising but requires deeper investigation. Translation of findings from the specialty clinic to the population setting, although challenging, will enhance uniformity of outcomes. More longitudinal population-based studies on cognitive ageing and MCI need to be performed to clarify all these issues. © 2014 The Association for the Publication of the Journal of Internal Medicine.

  4. Normobaric hypoxia overnight impairs cognitive reaction time.

    PubMed

    Pramsohler, Stephan; Wimmer, Stefan; Kopp, Martin; Gatterer, Hannes; Faulhaber, Martin; Burtscher, Martin; Netzer, Nikolaus Cristoph

    2017-05-15

    Impaired reaction time in patients suffering from hypoxia during sleep, caused by sleep breathing disorders, is a well-described phenomenon. High altitude sleep is known to induce periodic breathing with central apneas and oxygen desaturations, even in perfectly healthy subjects. However, deficits in reaction time in mountaineers or workers after just some nights of hypoxia exposure are not sufficiently explored. Therefore, we aimed to investigate the impact of sleep in a normobaric hypoxic environment on reaction time divided by its cognitive and motoric components. Eleven healthy non acclimatized students (5f, 6m, 21 ± 2.1 years) slept one night at a simulated altitude of 3500 m in a normobaric hypoxic room, followed by a night with polysomnography at simulated 5500 m. Preexisting sleep disorders were excluded via BERLIN questionnaire. All subjects performed a choice reaction test (SCHUHFRIED RT, S3) at 450 m and directly after the nights at simulated 3500 and 5500 m. We found a significant increase of cognitive reaction time with higher altitude (p = 0.026). No changes were detected in movement time (p = n.s.). Reaction time, the combined parameter of cognitive- and motoric reaction time, didn't change either (p = n.s.). Lower SpO2 surprisingly correlated significantly with shorter cognitive reaction time (r = 0.78, p = 0.004). Sleep stage distribution and arousals at 5500 m didn't correlate with reaction time, cognitive reaction time or movement time. Sleep in hypoxia does not seem to affect reaction time to simple tasks. The component of cognitive reaction time is increasingly delayed whereas motoric reaction time seems not to be affected. Low SpO2 and arousals are not related to increased cognitive reaction time therefore the causality remains unclear. The fact of increased cognitive reaction time after sleep in hypoxia, considering high altitude workers and mountaineering operations with overnight stays, should be further investigated.

  5. Cognitive rehabilitation in patients with nonamnestic mild cognitive impairment

    PubMed Central

    Barekatain, Majid; Alavirad, Maryam; Tavakoli, Mahgol; Emsaki, Golita; Maracy, Mohammad Reza

    2016-01-01

    Background: The nonamnesic type of mild cognitive impairment (na-MCI) is predementia state with subtle decline incognitive domains except memory. Although cognitive rehabilitation (CR) has been investigated in amnesic type of MCI, we could not find any trial that rehabilitated na-MCI exclusively. We studied the effectiveness of CR on na-MCI. Materials and Methods: This study was a blinded, randomized clinical trial. Individuals with age of 60 years or more, complete self-directedness and diagnosis of na-MCI, based on Neuropsychiatry Unit Cognitive assessment tool, were selected. The 51 patients were randomly assigned into three groups: CR, lifestyle (LS) modification, and the control group (CG). Neuropsychological tests for executive functioning were assessed at the baseline, after the interventions, and 6 months later. Results: The mean score of the “design fluency” test increased significantly in CR, compared to LS and CG (P = 0.007). In “five-point” test, mean score increased significantly in CR (P = 0.03). There was higher mean score of Behavioral Rating Inventory of Executive Function for adults in CR (P = 0.01). Conclusion: Consideration of the MCI subtypes allows us to target specific cognitive domains, such as information processing, for better CR outcome. CR may result in better performance of executive functioning of daily living. PMID:28250778

  6. Biomarkers for Cognitive Impairment in Parkinson Disease

    PubMed Central

    Shi, Min; Huber, Bertrand R.; Zhang, Jing

    2010-01-01

    Cognitive impairment, including dementia, is commonly seen in those afflicted with Parkinson disease (PD), particularly at advanced disease stages. Pathologically, PD with dementia (PD-D) is most often associated with the presence of cortical Lewy bodies, as is the closely related dementia with Lewy bodies (DLB). Both PD-D and DLB are also frequently complicated by the presence of neurofibrillary tangles and amyloid plaques, features most often attributed to Alzheimer disease. Biomarkers are urgently needed to differentiate among these disease processes and predict dementia in PD as well as monitor responses of patients to new therapies. A few clinical assessments, along with structural and functional neuroimaging, have been utilized in the last few years with some success in this area. Additionally, a number of other strategies have been employed to identify biochemical/molecular biomarkers associated with cognitive impairment and dementia in PD, e.g., targeted analysis of candidate proteins known to be important to PD pathogenesis and progression in cerebrospinal fluid or blood. Finally, interesting results are emerging from preliminary studies with unbiased and high throughput genomic, proteomic and metabolomic techniques. The current findings and perspectives of applying these strategies and techniques are reviewed in this article, together with potential areas of advancement. PMID:20522092

  7. Recognition memory deficits in mild cognitive impairment.

    PubMed

    Algarabel, Salvador; Fuentes, Manuel; Escudero, Joaquín; Pitarque, Alfonso; Peset, Vicente; Mazón, José-Francisco; Meléndez, Juan-Carlos

    2012-09-01

    There is no agreement on the pattern of recognition memory deficits characteristic of patients diagnosed with mild cognitive impairment (MCI). Whereas lower performance in recollection is the hallmark of MCI, there is a strong controversy about possible deficits in familiarity estimates when using recognition memory tasks. The aim of this research is to shed light on the pattern of responding in recollection and familiarity in MCI. Five groups of participants were tested. The main participant samples were those formed by two MCI groups differing in age and an Alzheimer's disease group (AD), which were compared with two control groups. Whereas one of the control groups served to assess the performance of the MCI and AD people, the other one, composed of young healthy participants, served the purpose of evaluating the adequacy of the experimental tasks used in the evaluation of the different components of recognition memory. We used an associative recognition task as a direct index of recollection and a choice task on a pair of stimuli, one of which was perceptually similar to those studied in the associative recognition phase, as an index of familiarity. Our results indicate that recollection decreases with age and neurological status, and familiarity remains stable in the elderly control sample but it is deficient in MCI. This research shows that a unique encoding situation generated deficits in recollective and familiarity mechanisms in mild cognitive impaired individuals, providing evidence for the existence of deficits in both retrieval processes in recognition memory in a MCI stage.

  8. Behavioral symptoms related to cognitive impairment

    PubMed Central

    Dillon, Carol; Serrano, Cecilia M; Castro, Diego; Leguizamón, Patricio Perez; Heisecke, Silvina L; Taragano, Fernando E

    2013-01-01

    Neuropsychiatric symptoms (NPS) are core features of Alzheimer’s disease and related dementias. On one hand, behavioral symptoms in patients with mild cognitive impairment (MCI) can indicate an increased risk of progressing to dementia. On the other hand, mild behavioral impairment (MBI) in patients who usually have normal cognition indicates an increased risk of developing dementia. Whatever the cause, all dementias carry a high rate of NPI. These symptoms can be observed at any stage of the disease, may fluctuate over its course, are a leading cause of stress and overload for caregivers, and increase rates of hospitalization and early institutionalization for patients with dementia. The clinician should be able to promptly recognize NPI through the use of instruments capable of measuring their frequency and severity to support diagnosis, and to help monitor the treatment of behavioral symptoms. The aims of this review are to describe and update the construct ‘MBI’ and to revise the reported NPS related to prodromal stages of dementia (MCI and MBI) and dementia stages of Alzheimer’s disease and frontotemporal lobar degeneration. PMID:24092982

  9. Cognitive Impairment in Chronic Obstructive Pulmonary Disease

    PubMed Central

    Crişan, Alexandru F.; Oancea, Cristian; Timar, Bogdan; Fira-Mladinescu, Ovidiu; Crişan, Alexandru; Tudorache, Voicu

    2014-01-01

    Background/Purpose Chronic obstructive pulmonary disease (COPD), especially in severe forms, is commonly associated with multiple cognitive problems. Montreal Cognitive Assessment test (MoCA) is used to detect cognitive impairment evaluating several areas: visuospatial, memory, attention and fluency. Our study aim was to evaluate the impact of stable COPD and exacerbation (AECOPD) phases on cognitive status using MoCA questionnaire. Methods We enrolled 39 patients (pts), smokers with COPD group D (30 stable and 9 in AECOPD) and 13 healthy subjects (control group), having similar level of education and no significant differences regarding the anthropometric measurements. We analyzed the differences in MoCA score between these three groups and also the correlation between this score and inflammatory markers. Results Patients with AECOPD had a significant (p<0.001) decreased MoCA score (14.6±3.4) compared to stable COPD (20.2±2.4) and controls (24.2±5.8). The differences between groups were more accentuated for the language abstraction and attention (p<0.001) and delayed recall and orientation (p<0.001) sub-topics. No significant variance of score was observed between groups regarding visuospatial and naming score (p = 0.095). The MoCA score was significantly correlated with forced expiratory volume (r = 0.28) and reverse correlated with C-reactive protein (CRP) (r = −0.57), fibrinogen (r = −0.58), erythrocyte sedimentation rate (ESR) (r = −0.55) and with the partial pressure of CO2 (r = −0.47). Conclusions According to this study, COPD significantly decreases the cognitive status in advanced and acute stages of the disease. PMID:25033379

  10. Screening for cognitive impairment in the elderly.

    PubMed Central

    Bush, C.; Kozak, J.; Elmslie, T.

    1997-01-01

    OBJECTIVE: To evaluate the extent and type of screening for cognitive impairment primary care physicians use for their elderly patients, to identify perceived barriers to screening, and to explore whether physicians would be willing to use the clock drawing test as a cognitive screening tool. DESIGN: Mailed questionnaire. SETTING: Primary care practices in the Ottawa-Carleton region. PARTICIPANTS: Family physicians and general practitioners culled from the Yellow Pages and Canadian Medical Directory; 368 of 568 questionnaires were returned for a response rate of 70%. Six respondents had fewer than 30 patients weekly and two responded too late to be included in the analysis; 360 cases were included in the analysis. MAIN OUTCOME MEASURES: Responses to 10 questions on cognitive screening and five on demographics and the nature of respondents' practices. RESULTS: About 80% of respondents reported doing at least one mental status examination during the past year. Only 24% routinely screened patients, although 82% believed screening was needed. Major barriers to cognitive screening were lack of time, risk of offending patients, and possible negative consequences of follow up. Clock drawing was perceived as an acceptable method of screening, if it were proven effective. CONCLUSIONS: Most primary care physicians believe cognitive screening is needed, but few routinely screen their elderly patients. Lack of time is the most important perceived barrier to screening. Primary care physicians are receptive to using the clock drawing test, and, because it is not time-consuming, are less likely to consider lack of time a barrier to testing. The clock test might help bridge the gap between perceived need for screening and actual screening. PMID:9356757

  11. The Experience of Cognitive Impairment in People with Psychosis.

    PubMed

    Wood, Helen; Cupitt, Caroline; Lavender, Tony

    2015-01-01

    Cognitive impairment has been widely studied in people with psychosis. However, research is lacking into the subjective experience of cognitive impairment, its impact and ways in which individuals cope. This study aimed to provide an account of the experience of cognitive impairment in people with a diagnosis of schizophrenia, including what difficulties people experience, how these difficulties are understood, how people respond to these difficulties and how they perceive others' views of these difficulties. A semi-structured interview was carried out with eight participants with a diagnosis of schizophrenia focusing on participants' experiences of difficulties with cognitive functioning. Interpretative phenomenological analysis was used to analyse interview transcripts. Experience of cognitive impairment was understood in terms of six master themes: impaired controlled thinking, physical sensations and impaired movement, explanations for the impairment and comparisons to the past, managing the impairment, how others see the impairment and anticipating the future. This study is the first rigorous qualitative study of the subjective experience of cognitive impairment in people with psychosis, and it provides greater context for empirical findings. The results have significant implications for clinical psychology, including education about cognitive difficulties and the importance of cognitive functioning to formulation. New areas for research include coping strategies in relation to functioning and future perspectives, ascertaining staff understanding of cognitive impairment, and reflective conversation style as an intervention for metacognitive difficulties. Key Practitioner Message Difficulties with cognitive functioning should be considered in clinical practitioners' formulations of clients' difficulties in the context of psychosis. Services should consider providing service user and carer education about cognitive impairment in psychosis. Staff may need further

  12. Dispositional Optimism and Incidence of Cognitive Impairment in Older Adults.

    PubMed

    Gawronski, Katerina A B; Kim, Eric S; Langa, Kenneth M; Kubzansky, Laura D

    2016-09-01

    Higher levels of optimism have been linked with positive health behaviors, biological processes, and health conditions that are potentially protective against cognitive impairment in older adults. However, the association between optimism and cognitive impairment has not been directly investigated. We examined whether optimism is associated with incident cognitive impairment in older adults. Data are from the Health and Retirement Study. Optimism was measured by using the Life Orientation Test-R and cognitive impairment with a modified version of the Telephone Interview for Cognitive Status derived from the Mini-Mental State Examination. Using multiple logistic regression models, we prospectively assessed whether optimism was associated with incident cognitive impairment in 4624 adults 65 years and older during a 4-year period. Among participants, 312 women and 190 men developed cognitive impairment during the 4-year follow-up. Higher optimism was associated with decreased risk of incident cognitive impairment. When adjusted for sociodemographic factors, each standard deviation increase in optimism was associated with reduced odds (odds ratio [OR] = 0.70, 95% confidence interval [CI] = 0.61-0.81) of becoming cognitively impaired. A dose-response relationship was observed. Compared with those with the lowest levels of optimism, people with moderate levels had somewhat reduced odds of cognitive impairment (OR = 0.78, 95% CI = 0.59-1.03), whereas people with the highest levels had the lowest odds of cognitive impairment (OR = 0.52, 95% CI = 0.36-0.74). These associations remained after adjusting for health behaviors, biological factors, and psychological covariates that could either confound the association of interest or serve on the pathway. Optimism was prospectively associated with a reduced likelihood of becoming cognitively impaired. If these results are replicated, the data suggest that potentially modifiable aspects of positive psychological functioning such

  13. Electrophysiological Biomarkers of Chemotherapy-related Cognitive Impairment and Recovery

    ClinicalTrials.gov

    2017-05-01

    Myelodysplastic Syndrome; Effects of Chemotherapy; Mild Cognitive Impairment; Multiple Myeloma; Non-hodgkin Lymphoma; Chronic Lymphocytic Leukemia; Acute Lymphoid Leukemia; Chronic Myeloid Leukemia; Acute Myeloid Leukemia

  14. Thalamic Shape and Cognitive Performance in Amnestic Mild Cognitive Impairment

    PubMed Central

    Hahn, Changtae; Lee, Chang-Uk; Won, Wang Yeon; Joo, Soo-Hyun

    2016-01-01

    Objective This study aimed to investigate thalamic shape alterations and their relationships with various episodic memory impairments in subjects with amnestic mild cognitive impairment (aMCI). Methods We compared volumes and morphological alterations of the thalamus between aMCI subjects and healthy controls. In addition, we investigated the correlation between thalamic deformations and various memory impairments in aMCI subjects using a comprehensive neuropsychological battery. Results The normalized left thalamic volumes of the aMCI group were significantly smaller than those of the healthy control group (p<0.0001). aMCI subjects exhibited significant thalamic deformations in the left thalamic dorso-medial and antero-medial areas compared with healthy individuals. CERAD-K Word List Memory scores were significantly correlated with the left dorso-medial areas in aMCI subjects. There were no significant correlations between verbal fluency, Boston naming test, constructional praxis, Word List Recognition, and Visuospatial Recall scores and thalamic shape in aMCI subjects. Verbal delayed recall scores were also significantly correlated with the left dorso-medial areas in the aMCI group. Conclusion Structural alterations in the thalamic deformations in the left dorso-medial and antero-medial areas might be core underlying neurobiological mechanisms of thalamic dysfunction related to Word List Memory and delayed verbal recall in individuals with aMCI. PMID:27757128

  15. Drug therapies for cognitive impairment and dementia.

    PubMed

    Howland, Robert H

    2010-04-01

    Drugs currently approved by the U.S. Food and Drug Administration (FDA) for the treatment of Alzheimer's disease include acetylcholinesterase inhibitor drugs (tacrine [Cognex®], donepezil [Aricept®], rivastigmine [Exelon®, Exelon Patch®], and galantamine [Reminyl®, Razadyne®]) and glutamate-modulating drugs (memantine [Namenda®]). They do not halt the underlying degenerative process but can slow disease progression. Piracetam is a nonprescription noot ropic drug designated by the FDA as an orphan drug for myoclonic seizures. Clinical trials in a diverse group of patients with age-related dementia or cognitive impairment demonstrated a significant benefit, but the methodology of these studies is poor, and long-term effects are unknown. Other therapies discussed in this article include Ginkgo biloba, a nonprescription natural supplement, and Axona", designated by the FDA as a medical food.

  16. Cognitive impairment, retention and abstinence among cocaine abusers in cognitive-behavioral treatment.

    PubMed

    Aharonovich, Efrat; Nunes, Edward; Hasin, Deborah

    2003-08-20

    Cognitive-behavioral therapy (CBT) depends on adequate cognitive functioning in patients, but prolonged cocaine use may impair cognitive functioning. Therefore, cognitive impairment may impede the ability of cocaine abusers to benefit from CBT. To begin to address this issue, we investigated the relationship between cognitive impairment and two treatment outcomes, therapy completion and abstention. Eighteen carefully screened non-depressed cocaine-dependent patients in a psychopharmacological clinical trial were administered the MicroCog computerized battery to assess cognitive performance at treatment entry. T-tests were used to compare cognitive functioning between completers (patients remaining in treatment at least 12 weeks) and dropouts. The results indicated that treatment completers had demonstrated significantly better cognitive performance at baseline than patients who dropped out of treatment. Cognitive domains that significantly distinguished between treatment completers and dropouts were attention, mental reasoning and spatial processing. This study provides preliminary evidence that cognitive impairments may decrease treatment retention and abstinence in CBT of cocaine dependence.

  17. Dispositional Optimism and Incidence of Cognitive Impairment in Older Adults

    PubMed Central

    Gawronski, Katerina A.B.; Kim, Eric S.; Langa, Kenneth M.; Kubzansky, Laura D.

    2017-01-01

    Objective Higher levels of optimism have been linked with positive health behaviors, biological processes, and health conditions that are potentially protective against cognitive impairment in older adults. However, the association between optimism and cognitive impairment has not been directly examined. We examined whether optimism is associated with incident cognitive impairment in older adults. Methods Data are from the Health and Retirement Study, a nationally representative sample of older U.S. adults. Using multiple logistic regression models, we prospectively assessed whether optimism was associated with incident cognitive impairment in 4,624 adults aged 65+ over a four-year period. Results Among the 4,624 participants, 497 respondents developed cognitive impairment over the four-year follow-up (306 women and 191 men). Higher optimism was associated with decreased risk of incident cognitive impairment. When controlling for sociodemographic factors, each standard deviation increase in optimism was associated with reduced odds (OR=0.72, 95% CI, 0.62–0.83) of becoming cognitively impaired. A dose-response relationship was observed. Compared to those with the lowest levels of optimism, people with moderate levels of optimism had somewhat reduced odds of cognitive impairment (OR=0.79, 95% CI, 0.59–1.03), while people with the highest levels of optimism had the lowest odds of cognitive impairment (OR=0.53, 95% CI, 0.35–0.78). These associations remained after adjusting for health behaviors, biological factors, and psychological covariates that could either confound the association of interest or serve on the pathway. Conclusions Optimism was prospectively associated with a reduced likelihood of becoming cognitively impaired. If these results are replicated, the data suggest that potentially modifiable aspects of positive psychological functioning such as optimism play an important role in maintaining cognitive functioning. Thus, these factors may prove

  18. Multimorbidity and Risk of Mild Cognitive Impairment.

    PubMed Central

    Vassilaki, Maria; Aakre, Jeremiah A.; Cha, Ruth H.; Kremers, Walter K.; St. Sauver, Jennifer L.; Mielke, Michelle M.; Geda, Yonas E.; Machulda, Mary M.; Knopman, David S.; Petersen, Ronald C.; Roberts, Rosebud O

    2015-01-01

    OBJECTIVES To determine the association of multiple chronic conditions with risk of incident mild cognitive impairment (MCI)/dementia. DESIGN Prospective cohort study SETTING Olmsted County, Minnesota. PARTICIPANTS Cognitively normal individuals (N=2,176) enrolled in the Mayo Clinic Study of Aging (MCSA). MEASUREMENTS Participants were randomly selected from the community and evaluated by a study coordinator, a physician, and underwent neuropsychometric testing at baseline and at 15-month intervals to assess diagnoses of MCI and dementia. We electronically captured information on International Classification of Diseases, ninth revision (ICD-9) codes for chronic conditions in the five years prior to enrollment using the Rochester Epidemiology Project medical records linkage system. We defined multimorbidity as having two or more chronic conditions and examined the association of multimorbidity with MCI/dementia using Cox proportional hazards models. RESULTS Among 2,176 cognitively normal participants (mean [±SD] age 78.5 [±5.2] years; 50.6% men), 1,884 (86.6%) had multimorbidity. The risk of MCI/dementia was elevated in persons with multimorbidity (hazard ratio [HR]: 1.38; 95% confidence interval [CI], 1.05–1.82). The HR was stronger in persons with ≥4 conditions (HR: 1.61; 95%CI, 1.21–2.13) compared to persons with only 0 or 1 conditions, and for men (HR: 1.53, 95% CI, 1.01– 2.31) than for women (HR: 1.20, 95% CI, 0.83– 1.74). CONCLUSION In older adults, having multiple chronic conditions is associated with an increased risk of MCI/dementia. This is consistent with the hypothesis that multiple etiologies may contribute to MCI and late-life dementia. Preventing chronic diseases may be beneficial in delaying or preventing MCI or dementia. PMID:26311270

  19. White Matter Damage and Cognitive Impairment after Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Kinnunen, Kirsi Maria; Greenwood, Richard; Powell, Jane Hilary; Leech, Robert; Hawkins, Peter Charlie; Bonnelle, Valerie; Patel, Maneesh Chandrakant; Counsell, Serena Jane; Sharp, David James

    2011-01-01

    White matter disruption is an important determinant of cognitive impairment after brain injury, but conventional neuroimaging underestimates its extent. In contrast, diffusion tensor imaging provides a validated and sensitive way of identifying the impact of axonal injury. The relationship between cognitive impairment after traumatic brain injury…

  20. Selective Impairment of Auditory Selective Attention under Concurrent Cognitive Load

    ERIC Educational Resources Information Center

    Dittrich, Kerstin; Stahl, Christoph

    2012-01-01

    Load theory predicts that concurrent cognitive load impairs selective attention. For visual stimuli, it has been shown that this impairment can be selective: Distraction was specifically increased when the stimulus material used in the cognitive load task matches that of the selective attention task. Here, we report four experiments that…

  1. Mnemonic Strategy Instruction for Beginning Readers with Cognitive Impairments

    ERIC Educational Resources Information Center

    Burton, Rivka

    2013-01-01

    Many students with cognitive impairments are not afforded the opportunity to develop their potential as readers. A review of the literature reveals that few researchers have evaluated the effects of phonics instruction on the reading skills of students with cognitive impairments. The purpose of this study was to test the effectiveness of a…

  2. White Matter Damage and Cognitive Impairment after Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Kinnunen, Kirsi Maria; Greenwood, Richard; Powell, Jane Hilary; Leech, Robert; Hawkins, Peter Charlie; Bonnelle, Valerie; Patel, Maneesh Chandrakant; Counsell, Serena Jane; Sharp, David James

    2011-01-01

    White matter disruption is an important determinant of cognitive impairment after brain injury, but conventional neuroimaging underestimates its extent. In contrast, diffusion tensor imaging provides a validated and sensitive way of identifying the impact of axonal injury. The relationship between cognitive impairment after traumatic brain injury…

  3. Selective Impairment of Auditory Selective Attention under Concurrent Cognitive Load

    ERIC Educational Resources Information Center

    Dittrich, Kerstin; Stahl, Christoph

    2012-01-01

    Load theory predicts that concurrent cognitive load impairs selective attention. For visual stimuli, it has been shown that this impairment can be selective: Distraction was specifically increased when the stimulus material used in the cognitive load task matches that of the selective attention task. Here, we report four experiments that…

  4. Cognitive impairment in affective psychoses: a meta-analysis.

    PubMed

    Bora, Emre; Yücel, Murat; Pantelis, Christos

    2010-01-01

    It has recently been suggested that cognitive impairment should be included in the diagnostic criteria of schizophrenia. One of the main arguments in support of this suggestion has been the hope that cognitive impairment can help distinguish schizophrenia from bipolar disorder (BD). However, recent evidence shows that cognitive deficits occur in BD and persist beyond euthymia. Further, mood disorders with psychotic features might be expected to manifest greater cognitive impairment, which further complicates the potential to differentiate these disorders. The goal of the current meta-analysis was to examine the magnitude and characteristics of cognitive impairments in affective psychoses (AP). A systematic search of the existing literature sourced 27 studies that met the inclusion criteria. These studies compared cognitive performances of 763 patients with AP (550 BD and 213 major depressive disorder) and 1823 healthy controls. Meta-regression and subgroup analyses were used to examine the effects of moderator variables. Meta-analyses of these studies showed that patients with AP were impaired in all 15 cognitive tasks with large effect sizes for most measures. There were no significant differences between the magnitude of impairments between the BD and major depressive disorder groups. The largest effect size was found for symbol coding, stroop task, verbal learning, and category fluency, reflecting impairments in elementary and complex aspects of attentional processing, as well as learning and memory. In general, the pattern of cognitive impairments in AP was similar to reported findings in euthymic patients with BD, but relatively more pronounced.

  5. Parental Cognitive Impairment and Child Maltreatment in Canada

    ERIC Educational Resources Information Center

    McConnell, David; Feldman, Maurice; Aunos, Marjorie; Prasad, Narasimha

    2011-01-01

    Objectives: The aim of this study was to determine the prevalence of parental cognitive impairment in cases opened for child maltreatment investigation in Canada, and to examine the relationship between parental cognitive impairment and maltreatment investigation outcomes including substantiation, case disposition and court application. Methods:…

  6. Cognitive impairment in epilepsy: the role of network abnormalities.

    PubMed

    Holmes, Gregory L

    2015-06-01

    The challenges to individuals with epilepsy extend far beyond the seizures. Co-morbidities in epilepsy are very common and are often more problematic to individuals than the seizures themselves. In this review, the pathophysiological mechanisms of cognitive impairment are discussed. While aetiology of the epilepsy has a significant influence on cognition, there is increasing evidence that prolonged or recurrent seizures can cause or exacerbate cognitive impairment. Alterations in signalling pathways and neuronal network function play a major role in both the pathophysiology of epilepsy and the epilepsy comorbidities. However, the biological underpinnings of cognitive impairment can be distinct from the pathophysiological processes that cause seizures.

  7. Numerical Cognition in Bees and Other Insects

    PubMed Central

    Pahl, Mario; Si, Aung; Zhang, Shaowu

    2013-01-01

    The ability to perceive the number of objects has been known to exist in vertebrates for a few decades, but recent behavioral investigations have demonstrated that several invertebrate species can also be placed on the continuum of numerical abilities shared with birds, mammals, and reptiles. In this review article, we present the main experimental studies that have examined the ability of insects to use numerical information. These studies have made use of a wide range of methodologies, and for this reason it is striking that a common finding is the inability of the tested animals to discriminate numerical quantities greater than four. Furthermore, the finding that bees can not only transfer learnt numerical discrimination to novel objects, but also to novel numerosities, is strongly suggestive of a true, albeit limited, ability to count. Later in the review, we evaluate the available evidence to narrow down the possible mechanisms that the animals might be using to solve the number-based experimental tasks presented to them. We conclude by suggesting avenues of further research that take into account variables such as the animals’ age and experience, as well as complementary cognitive systems such as attention and the time sense. PMID:23616774

  8. [Cognitive impairments accompanying the burnout syndrome - a review].

    PubMed

    Riedrich, Karin; Weiss, Elisabeth M; Dalkner, Nina; Reininghaus, Eva; Papousek, Ilona; Schwerdtfeger, Andreas; Lackner, Helmut K; Reininghaus, Bernd

    2017-03-01

    The rising prevalence of the burnout syndrome has increasingly moved it into the focus of scientific interest. In addition to emotional exhaustion and depersonalization, particularly reduced personal accomplishment has strong societal and economic effects. In recent years reduced personal accomplishment has increasingly been linked to cognitive impairment. However, up to now only a few studies have objectively assessed cognitive deficits in burnout patients. This article gives an overview of 16 studies which examined cognitive abilities in burnout patients. The findings are partly contradictory, probably due to methodical differences. Consensus has emerged concerning impairments of executive functions, i.a. vigilance, and memory updating and monitoring. Multifactorial causation may underlie the cognitive impairments. Targeted longitudinal studies are necessary in order to identify the affected cognitive functions and be able to make causal inferences on links between the burnout syndrome and specific cognitive impairments.

  9. Prevalence of Cognitive Impairment without Dementia in the United States

    PubMed Central

    Plassman, Brenda L.; Langa, Kenneth M.; Fisher, Gwenith G.; Heeringa, Steven G.; Weir, David R.; Ofstedal, Mary Beth; Burke, James R.; Hurd, Michael D.; Potter, Guy G.; Rodgers, Willard L.; Steffens, David C.; McArdle, John J.; Willis, Robert J.; Wallace, Robert B.

    2009-01-01

    Background Cognitive impairment without dementia is associated with increased risk for disability, increased health care costs, and progression to dementia. There are no population-based prevalence estimates of this condition in the United States. Objective To estimate the prevalence of cognitive impairment without dementia in the United States and determine longitudinal cognitive and mortality outcomes. Design Longitudinal study from July 2001 to March 2005. Setting In-home assessment for cognitive impairment. Participants Participants in ADAMS (Aging, Demographics, and Memory Study) who were age 71 years or older drawn from the nationally representative HRS (Health and Retirement Study). Of 1770 selected individuals, 856 completed initial assessment, and of 241 selected individuals, 180 completed 16- to 18-month follow-up assessment. Measurements Assessments, including neuropsychological testing, neurologic examination, and clinical and medical history, were used to assign a diagnosis of normal cognition, cognitive impairment without dementia, or dementia. National prevalence rates were estimated by using a population-weighted sample. Results In 2002, an estimated 5.4 million people (22.2%) in the United States age 71 years or older had cognitive impairment without dementia. Prominent subtypes included prodromal Alzheimer disease (8.2%) and cerebrovascular disease (5.7%). Among participants who completed follow-up assessments, 11.7% with cognitive impairment without dementia progressed to dementia annually, whereas those with subtypes of prodromal Alzheimer disease and stroke progressed at annual rates of 17% to 20%. The annual death rate was 8% among those with cognitive impairment without dementia and almost 15% among those with cognitive impairment due to medical conditions. Limitations Only 56% of the nondeceased target sample completed the initial assessment. Population sampling weights were derived to adjust for at least some of the potential bias due to

  10. Effects of Computer Cognitive Training on Depression in Cognitively Impaired Seniors

    ERIC Educational Resources Information Center

    Allen, Nara L.

    2016-01-01

    The aim of the present study was to investigate the effects of a computer cognitive training program on depression levels in older mildly cognitive impaired individuals. Peterson et al. (1999), defines mild cognitive impairment (MCI) as a transitional stage in which an individual's memory deteriorates and his likelihood of developing Alzheimer's…

  11. Effects of Computer Cognitive Training on Depression in Cognitively Impaired Seniors

    ERIC Educational Resources Information Center

    Allen, Nara L.

    2016-01-01

    The aim of the present study was to investigate the effects of a computer cognitive training program on depression levels in older mildly cognitive impaired individuals. Peterson et al. (1999), defines mild cognitive impairment (MCI) as a transitional stage in which an individual's memory deteriorates and his likelihood of developing Alzheimer's…

  12. Cognitively Elite, Cognitively Normal, and Cognitively Impaired Aging: Neurocognitive Status and Stability Moderate Memory Performance

    PubMed Central

    Dixon, Roger A.; de Frias, Cindy M.

    2014-01-01

    Objective Although recent theories of brain and cognitive aging distinguish among normal, exceptional, and impaired groups, further empirical evidence is required. We adapted and applied standard procedures for classifying groups of cognitively impaired (CI) and cognitively normal (CN) older adults to a third classification, cognitively healthy, exceptional, or elite (CE) aging. We then examined concurrent and two-wave longitudinal performance on composite variables of episodic, semantic, and working memory. Method We began with a two-wave source sample from the Victoria Longitudinal Study (VLS) (source n=570; baseline age=53–90 years). The goals were to: (a) apply standard and objective classification procedures to discriminate three cognitive status groups, (b) conduct baseline comparisons of memory performance, (c) develop two-wave status stability and change subgroups, and (d) compare of stability subgroup differences in memory performance and change. Results As expected, the CE group performed best on all three memory composites. Similarly, expected status stability effects were observed: (a) stable CE and CN groups performed memory tasks better than their unstable counterparts and (b) stable (and chronic) CI group performed worse than its unstable (variable) counterpart. These stability group differences were maintained over two waves. Conclusion New data validate the expectations that (a) objective clinical classification procedures for cognitive impairment can be adapted for detecting cognitively advantaged older adults and (b) performance in three memory systems is predictably related to the tripartite classification. PMID:24742143

  13. Cognitively elite, cognitively normal, and cognitively impaired aging: neurocognitive status and stability moderate memory performance.

    PubMed

    Dixon, Roger A; de Frias, Cindy M

    2014-01-01

    Although recent theories of brain and cognitive aging distinguish between normal, exceptional, and impaired groups, further empirical evidence is required. We adapted and applied standard procedures for classifying groups of cognitively impaired (CI) and cognitively normal (CN) older adults to a third classification: cognitively healthy, exceptional, or elite (CE) aging. We then examined concurrent and two-wave longitudinal performance on composite variables of episodic, semantic, and working memory. We began with a two-wave source sample from the Victoria Longitudinal Study (VLS; source n = 570; baseline age = 53-90 years). The goals were to: (a) apply standard and objective classification procedures to discriminate three cognitive status groups, (b) conduct baseline comparisons of memory performance, (c) develop two-wave status stability and change subgroups, and (d) compare of stability subgroup differences in memory performance and change. As expected, the CE group performed best on all three memory composites. Similarly, expected status stability effects were observed: (a) stable CE and CN groups performed memory tasks better than their unstable counterparts, and (b) the stable (and chronic) CI group performed worse than its unstable (variable) counterpart. These stability group differences were maintained over two waves. New data validate the expectations that (a) objective clinical classification procedures for cognitive impairment can be adapted for detecting cognitively advantaged older adults, and (b) performance in three memory systems is predictably related to the tripartite classification.

  14. Diagnosis of vascular cognitive impairment and its main categories.

    PubMed

    Rodríguez García, P L; Rodríguez García, D

    2015-05-01

    A review of current criteria for the diagnosis of categories related with vascular cognitive impairment, in particular the nomenclature, diagnostic criteria, and differential clinical-radiological findings. The criteria for the diagnosis of vascular cognitive impairment have evolved, but available criteria were designed basically for differentiating between vascular dementia and dementia due to Alzheimer disease, and for research purposes. Nevertheless, in clinical practice precise elements are required for: 1) Clinical diagnosis of dementia and mild cognitive impairment; 2) Clinical and neuroimaging criteria for identification of the various cerebrovascular lesions associated with cognitive dysfunction, and 3) A formulation of the aetiogenic-pathogenic relationship between cognitive impairment and cerebrovascular lesions. For this reason, a review was carried out on the diagnostic elements of vascular cognitive impairment categories, classification, and their most relevant characteristics. It highlights the characteristic for the diagnosis of multi-infarction dementia, strategic single infarct dementia, small vessel disease with dementia, mixed dementia, and vascular mild cognitive impairment. Standardisation is required, by a multidisciplinary expert team, as regards nomenclature and criteria for the diagnosis of the full spectrum associated with vascular cognitive impairment and especially for vascular dementia and its categories. Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  15. Treating impaired cognition in schizophrenia: the case for combining cognitive-enhancing drugs with cognitive remediation.

    PubMed

    Michalopoulou, Panayiota G; Lewis, Shôn W; Wykes, Til; Jaeger, Judith; Kapur, Shitij

    2013-08-01

    Cognitive impairment is a well-documented feature of schizophrenia and represents a major impediment to the functional recovery of patients. The therapeutic strategies to improve cognition in schizophrenia have either used medications (collectively referred to as 'cognitive-enhancing drugs' in this article) or non-pharmacological training approaches ('cognitive remediation'). Cognitive-enhancing drugs have not as yet been successful and cognitive remediation has shown modest success. Therefore, we may need to explore new therapeutic paradigms to improve cognition in schizophrenia. The optimal approach may require a combination of cognitive-enhancing drugs with cognitive remediation. We review the available data from animal and human studies that provide the conceptual basis, proof-of-concept and illustrations of success of such combination strategies in experimental and clinical paradigms in other conditions. We address the major design issues relevant to the choice of the cognitive-enhancing drugs and cognitive remediation, as well as the timing and the duration of the intervention as will be relevant for schizophrenia. Finally, we address the practical realities of the development and testing of such combined approaches in the real-world clinical situation and conclude that while scientifically attractive, there are several practical difficulties to be overcome for this approach to be clinically feasible. Copyright © 2013 Elsevier B.V. and ECNP. All rights reserved.

  16. Sleep Habits in Mild Cognitive Impairment

    PubMed Central

    Hayes, Tamara L.; Riley, Thomas; Mattek, Nora; Pavel, Misha; Kaye, Jeffrey A.

    2013-01-01

    We explored the relationship between sleep disturbances and mild cognitive impairment (MCI) in community-dwelling seniors. Recent evidence suggests that sleep habits are differentially compromised in different subtypes of MCI, but the relationship between sleep disruption and MCI remains poorly understood. We gathered daily objective measures of sleep disturbance from 45 seniors, including 16 with MCI (mean age 86.9 ± 4.3 years), over a six month period. We also collected self-report measures of sleep disturbance. Although there were no differences between groups in any of our self-report measures, we found that amnestic MCI (aMCI) volunteers had less disturbed sleep than both non-amnestic MCI (naMCI) and cognitively intact volunteers, as measured objectively by movement in bed at night (F2,1078=4.30, p=0.05), wake after sleep onset (F2,1078=41.6, p<0.001), and times up at night (F2,1078=26.7, p<0.001). The groups did not differ in total sleep time. In addition, the aMCI group had less day-to-day variability in these measures than the intact and naMCI volunteers. In general, the naMCI volunteers showed a level of disturbed sleep that was intermediate to that of aMCI and intact volunteers. These differences in sleep disruption between aMCI and naMCI may be related to differences in the pathology underlying these MCI subtypes. PMID:24145694

  17. The effects of cognitive intervention on cognitive impairments after intensive care unit admission.

    PubMed

    Zhao, Jingjing; Yao, Li; Wang, Changqing; Sun, Yun; Sun, Zhongwu

    2017-04-01

    Patients who survive critical illness commonly suffer cognitive impairments. We aimed to study the effects of cognitive intervention to treat the long-term impairments observed among different populations of intensive care unit (ICU) survivors. The results showed that the intervention significantly suppressed the deterioration of cognitive function in these patients. Medical and neurological ICU survivors were more susceptible than post-anaesthesia ICU patients to severe cognitive damage. In the former, the deterioration of impairments can be slowed by cognitive intervention. In comparison, intervention exerted significantly positive effects on the recovery of the cognitive functions of post-anaesthesia care unit patients. Furthermore, young populations were more likely than older populations to recover from acute cognitive impairments, and the impairment observed among the older population seemed to be multi-factorial and irreversible.

  18. Post-stroke cognitive impairment: epidemiology, mechanisms and management

    PubMed Central

    Sun, Jia-Hao

    2014-01-01

    Post-stroke cognitive impairment occurs frequently in the patients with stroke. The prevalence of post-stroke cognitive impairment ranges from 20% to 80%, which varies for the difference between the countries, the races, and the diagnostic criteria. The risk of post-stroke cognitive impairment is related to both the demographic factors like age, education and occupation and vascular factors. The underlying mechanisms of post-stroke cognitive impairment are not known in detail. However, the neuroanatomical lesions caused by the stroke on strategic areas such as the hippocampus and the white matter lesions (WMLs), the cerebral microbleeds (CMBs) due to the small cerebrovascular diseases and the mixed AD with stroke, alone or in combination, contribute to the pathogenesis of post-stroke cognitive impairment. The treatment of post-stroke cognitive impairment may benefit not only from the anti-dementia drugs, but also the manage measures on cerebrovascular diseases. In this review, we will describe the epidemiological features and the mechanisms of post-stroke cognitive impairment, and discuss the promising management strategies for these patients. PMID:25333055

  19. Reduced interhemispheric inhibition in mild cognitive impairment.

    PubMed

    Tsutsumi, Ryosuke; Hanajima, Ritsuko; Hamada, Masashi; Shirota, Yuichiro; Matsumoto, Hideyuki; Terao, Yasuo; Ohminami, Shinya; Yamakawa, Yoshihiro; Shimada, Hiroyuki; Tsuji, Shoji; Ugawa, Yoshikazu

    2012-04-01

    In mild cognitive impairment (MCI), the corpus callosum is known to be affected structurally. We evaluated callosal function by interhemispheric inhibition (IHI) using transcranial magnetic stimulation (TMS) in MCI patients. We investigated 12 amnestic MCI patients and 16 healthy age-matched control subjects. The IHI was studied with a paired-pulse TMS technique. The conditioning TMS was given over the right primary motor cortex (M1) and the test TMS over the left M1. Motor evoked potentials were recorded from the relaxed first dorsal interosseous muscle. We also studied other motor cortical circuit functions; short-latency afferent inhibition (SAI), short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF). Both the amount of IHI and SAI were significantly reduced in MCI patients as compared with control subjects, whereas SICI or ICF did not differ between them. The degree of IHI significantly correlated with neither the mini-mental state examination score nor the degree of SAI. Our results suggest that transcallosal connection between bilateral M1 is primarily involved in MCI, regardless of SAI dysfunction.

  20. Impaired financial abilities in Parkinson's disease patients with mild cognitive impairment and dementia.

    PubMed

    Martin, Roy C; Triebel, Kristen L; Kennedy, Richard E; Nicholas, Anthony P; Watts, Ray L; Stover, Natividad P; Brandon, Mariko; Marson, Daniel C

    2013-11-01

    Financial capacity (FC) is an instrumental activity of daily living (IADL) critical to independent functioning and sensitive to cognitive impairment in dementia. Little is known about FC in cognitively impaired patients with Parkinson's disease (PD). The present study investigated FC in PD patients with prodromal and clinical dementia. Participants were 20 older controls and 35 PD patients who met consensus criteria for either mild cognitive impairment (PD-MCI, n = 18) or PD dementia (PDD, n = 17). FC was assessed using a standardized performance based measure consisting of 9 domain and two global scores (Financial Capacity Instrument; FCI) (1). FCI domain and global performance scores were compared across groups. Capacity impairment ratings (no impairment, mild/moderate impairment, severe impairment) were calculated for each PD patient's domain and global scores. Relative to controls, PD-MCI patients were impaired on both FCI global scores and domains of basic monetary skills, financial concepts, and investment decision-making. Relative to both controls and PD-MCI patients, PDD patients were impaired on virtually all FCI variables. With respect to impairment ratings, greater than 50% of PD-MCI patients and greater than 90% of PDD patients were classified as either mild/moderate or severely impaired on the two FCI global scores. Impairment of financial capacity is already present in PD-MCI and is advanced in PDD. Complex cognitively-mediated IADLs such as financial capacity appear to be impaired early in the course of PD dementia. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Impairment in cognitive and affective empathy in patients with brain lesions: anatomical and cognitive correlates.

    PubMed

    Shamay-Tsoory, S G; Tomer, R; Goldsher, D; Berger, B D; Aharon-Peretz, J

    2004-11-01

    The present study was designed to examine the degree of impairment in cognitive and affective empathy among patients with focal brain lesions, and the contribution of specific cognitive abilities (such as cognitive flexibility and processing of emotional information), to empathy. The cognitive and affective empathic response of patients with localized prefrontal lesions (n=36) was compared to responses of patients with parietal lesions (n=15) and healthy control subjects (n=19). Results indicate that patients with prefrontal lesions (especially those with lesions involving the orbitoprefrontal and medial regions) were significantly impaired in both cognitive and affective empathy as compared to parietal patients and healthy controls. When the damage was restricted to the prefrontal cortex, either left- or right-hemisphere lesions resulted in impaired empathy. However, when the lesion involved the right hemisphere, patients with parietal lesions were also impaired. The pattern of relationships between cognitive performance and empathy suggested dissociation between the cognitive correlates of affective and cognitive empathy.

  2. Cataract and Cognitive Impairment: A Review of the Literature

    PubMed Central

    Jefferis, Joanna M; Mosimann, Urs P; Clarke, Michael P

    2014-01-01

    Acquired cataract and cognitive impairment are both common age related problems, and ophthalmologists are increasingly likely to encounter patients who have both. Dementia types which display early visuo-perceptual impairment may present first to ophthalmology services. When these patients have coexisting cataract it may be difficult to distinguish visual complaints due to cataract from those due to dementia. The interaction between visual impairment due to cataract, and neurodegenerative disorders affecting the central visual pathways, is not fully understood. Visual impairment due to cataract may stress impaired attentional mechanisms, and cataract extraction may improve cognitive performance in some patients with early cognitive impairment; however the benefits of cataract surgery in established dementia are less clear. Here we review the literature on this subject and consider the implications for practice. PMID:20807709

  3. Positive Effects of Computer-Based Cognitive Training in Adults with Mild Cognitive Impairment

    ERIC Educational Resources Information Center

    Herrera, C.; Chambon, C.; Michel, B. F.; Paban, V.; Alescio-Lautier, B.

    2012-01-01

    Considering the high risk for individuals with amnestic Mild Cognitive Impairment (A-MCI) to progress towards Alzheimer's disease (AD), we investigated the efficacy of a non-pharmacological intervention, that is, cognitive training that could reduce cognitive difficulties and delay the cognitive decline. For this, we evaluated the efficacy of a…

  4. Positive Effects of Computer-Based Cognitive Training in Adults with Mild Cognitive Impairment

    ERIC Educational Resources Information Center

    Herrera, C.; Chambon, C.; Michel, B. F.; Paban, V.; Alescio-Lautier, B.

    2012-01-01

    Considering the high risk for individuals with amnestic Mild Cognitive Impairment (A-MCI) to progress towards Alzheimer's disease (AD), we investigated the efficacy of a non-pharmacological intervention, that is, cognitive training that could reduce cognitive difficulties and delay the cognitive decline. For this, we evaluated the efficacy of a…

  5. [Current approaches to management of patients with mild cognitive impairment].

    PubMed

    Zakharov, V V; Gromova, D O

    2017-01-01

    Mild cognitive impairment (MCI) is an intermediate stage between normal aging and dementia. The prevalence of MCI among elderly people is 12-17% but the risk of progression of cognitive impairment and development of dementia during 5 years is up to 70%. Cerebral vascular diseases and initial stages of neurodegenerative processes are the cause of MCI. Clinical characteristics of MCI depend on the main etiological factor. To decrease the severity of symptoms and prevent the progression of cognitive impairment in MCI patients, pharmacotherapy and non-medication methods, including diet optimization, stimulation of mental and physical activity, are used. Dopaminergic and noradrenergic therapy is most prevalent among pharmacological methods.

  6. DNA-repair in mild cognitive impairment and Alzheimer's disease.

    PubMed

    Bucholtz, Nina; Demuth, Ilja

    2013-10-01

    While the pathogenesis of the sporadic form of Alzheimer disease (late onset Alzheimer disease, LOAD) is not fully understood, it seems to be clear that a combination of genetic and environmental factors are involved and influence the course of the disease. Among these factors, elevated levels of oxidative stress have been recognized and individual differences in the capacity to deal with DNA damage caused by its effects have been the subject of numerous studies. This review summarizes the research on DNA repair proteins and genes in the context of LOAD pathogenesis and its possible prodromal stage, mild cognitive impairment (MCI). The current status of the research in this field is discussed with respect to methodological issues which might have compromised the outcome of some studies and future directions of investigation on this subject are depicted.

  7. The Risk of Incident Mild Cognitive Impairment and Progression to Dementia Considering Mild Cognitive Impairment Subtypes

    PubMed Central

    Michaud, Tzeyu L.; Su, Dejun; Siahpush, Mohammad; Murman, Daniel L.

    2017-01-01

    Background It remains unclear how demographic and clinical characteristics are related to the risk of incident mild cognitive impairment (MCI) by its subtypes. Moreover, the contribution of the subtypes of incident MCI to the progression to dementia remains puzzling. Methods We used data collected by the National Alzheimer Coordinating Center. Our analysis sample included cognitively normal subjects at baseline. The associations were examined using competing-risks survival regression models and Cox proportional hazards models. Results About 16.3% of subjects developed incident MCI of whom 15.8% progressed to Alz­heimer disease (overall mean follow-up of 4.3 years). The risk of incident amnestic MCI (aMCI) was greater in subjects with 1 copy (subhazard ratio [SHR]: 1.23; 95% CI: 1.00–1.50) or 2 copies (SHR: 2.14; 95% CI: 1.49–3.05) of the APOE ε4 allele than in those who had no ε4 allele. Multiple-domain aMCI patients were more likely to progress to dementia than single-domain aMCI patients (hazard ratio: 2.14; 95% CI: 1.28–3.58). Conclusions Cognitively normal subjects with an APOE ε4 allele had a higher likelihood of developing aMCI and the MCI subtype was associated with the dementia subtype. Our findings provide important information about practical indicators for the prediction of cognitive decline. PMID:28413413

  8. Do subjective cognitive complaints correlate with cognitive impairment in systemic lupus erythematosus? A Danish outpatient study.

    PubMed

    Vogel, A; Bhattacharya, S; Larsen, J L; Jacobsen, S

    2011-01-01

    This study examined the prevalence of cognitive impairment and its association with depressive symptoms and self-reported cognitive complaints in Danish outpatients with systemic lupus erythematosus (SLE). Fifty-seven consecutive female SLE-outpatients were examined with a comprehensive neuropsychological test-battery, a 20-item self-administered Perceived Deficits Questionnaire (PDQ) and a self-rated depression scale (Major Depression Inventory). Twenty-two patients (38.5%) were classified as cognitively impaired, mostly with deficits in executive functions and attention. Among cognitively impaired patients only 18.2% had significantly higher PDQ scores than the normal range. PDQ scores were highly correlated to depressive symptoms (r = 0.67, p < 0.001). Only two neuropsychological tests were significantly correlated with subjective cognitive complaints. When these variables and self-rated depression score were entered into a regression model both depression score and Symbol Digit Modalities Test performances were significantly associated with the PDQ score. In conclusion, cognitive impairments were common in this group of (mild) SLE outpatients, but the level of significant subjective cognitive complaints was low even among patients with cognitive impairment. Affective status may influence subjective experience of cognitive functions even more than cognitive functioning itself, and absence of subjective cognitive complaints did not exclude the presence of cognitive impairments.

  9. Rorschach assessment of cognitive impairment from an object relations perspective.

    PubMed

    Lerner, P M

    1996-01-01

    In 1986, H. Lerner and P. Lerner proposed an object relations model of thinking that integrated Piaget's theory of early cognitive development with Mahler's theory of separation-individuation. They identified three distinct, interdigitated stages, outlined the cognitive task for each stage, detailed the necessary role and function of the stage-specific caregiving object, and suggested potential cognitive impairments associated with the object not fulfilling its function. Herein, this conceptual model is extended to the Rorschach. Rorschach indices of cognitive impairments associated with each stage were developed. The indices are then applied to the Rorschach records of children who were selected as prototypical of specific developmental disorders.

  10. Separating mood disturbance from mild cognitive impairment in geriatric depression.

    PubMed

    Steffens, David C

    2008-08-01

    Disentangling depression from dementia remains one of the most difficult clinical challenges for psychiatrists caring for older adults. The relationship between geriatric depression and dementia is complex for several reasons. First, cognitive impairment is often a prominent feature of depression in the elderly. Cognition may improve with successful treatment of depression but it may not normalize. Indeed, marked memory impairment in older depressed individuals may indicate a prodromal state of dementia. This review will examine issues related to depression and cognitive disorder in the elderly. The author will provide an evidence-based approach to separate mood disorder from cognitive disorder among older adults.

  11. Brain volumes, cognitive impairment, and conjugated equine estrogens.

    PubMed

    Espeland, Mark A; Tindle, Hilary A; Bushnell, Cheryl A; Jaramillo, Sarah A; Kuller, Lewis H; Margolis, Karen L; Mysiw, W Jerry; Maldjian, Joseph A; Melhem, Elias R; Resnick, Susan M

    2009-12-01

    Postmenopausal conjugated equine estrogens (CEE) therapies increase the risk of cognitive impairment in women aged 65 years or older and are associated with smaller regional brain volumes; however, the link between these two phenomena has not been established. Standardized magnetic resonance imaging was performed on 1,403 women, 1-4 years after they had participated in randomized placebo-controlled clinical trials of CEE-based therapies. Women included in this report were aged 65-80 years and free of dementia and mild cognitive impairment (MCI) when originally enrolled in the trials, which lasted an average of 4-6 years and were conducted at 14 academic U.S. medical centers. The associations that regional brain volumes and ischemic lesion volumes had with the development of cognitive impairment (i.e., dementia or MCI) were contrasted between treatment groups using analyses of covariance. Fifty-three women developed MCI or probable dementia during follow-up. Among women who had been prescribed CEE-based therapies, cognitive impairment was associated with relatively smaller hippocampal (p = .0002) and total brain volumes (p = .03). Qualitatively, these associations appeared to be independent of their level of pretreatment cognitive function. Among women who had been prescribed placebo, these relationships were not evident; instead, cognitive impairment was associated with greater ischemic lesion volume in the frontal lobe (p = .007) and overall (p = .02). A mechanism by which CEE-based postmenopausal hormone therapy induces cognitive impairment appears to be through increased brain atrophy.

  12. Early life influences on cognitive impairment among oldest old Chinese.

    PubMed

    Zhang, Zhenmei; Gu, Danan; Hayward, Mark D

    2008-01-01

    This article examines the effects of early life socioeconomic conditions on the risk of cognitive impairment among oldest old persons in China. We also examine whether adult socioeconomic status mediates the association between early life socioeconomic status and cognitive impairment in old age. Data derived from two waves (1998-2000) of the Chinese Longitudinal Healthy Longevity Survey. We estimated logistic and multinomial regression models of cognitive impairment for a nationwide sample of people aged 80 to 105 (N = 8,444). Among both men and women, urban residence in early life as well as education was associated with lower odds of cognitive impairment at baseline. We found modest support for a protective effect of advantaged childhood background on the odds of cognitive impairment onset during the 2-year follow-up, especially among women. Our findings suggest that socioeconomic environment throughout the life course, early life in particular, can influence the risk of cognitive impairment in old age. Not only can public policy that targets illiteracy, hunger, and poverty improve the lives of tens of thousands of children, but ultimately such investments will pay significant dividends many decades later in enhancing the cognitive well-being of older persons.

  13. Ethical Considerations in Electronic Monitoring of the Cognitively Impaired.

    PubMed

    Yang, Y Tony; Kels, Charles G

    2017-01-01

    Cognitive impairment afflicts an estimated 16 million people in the United States. Wandering is a concerning behavior associated with cognitive impairment, as it may threaten patient safety. The risks posed by wandering place severe burdens on both professional and informal caregivers, as well as law enforcement institutions throughout the United States. As such, location trackers that could reduce this burden have become increasingly prevalent. As with many assistive technologies, the substantial promise of location trackers is counterbalanced by potential pitfalls with respect to loss of privacy and autonomy. This article reviews the ethical issues raised by electronic monitoring of cognitively impaired persons, with the goal of transcending a narrow focus on decisional capacity in favor of a patient-centered framework that is applicable and adjustable at different stages of cognitive decline. Balancing the ethical principles of beneficence and respect in treating cognitively impaired persons goes beyond the necessary step of evaluating decision-making capacity to include partnering with families, caretakers, and cognitively impaired individuals who wander in a collaborative coalition of care. An approach emphasizing the individual needs of patients and caretakers is best suited to finding solutions that implement tracking technologies in ways that both protect and empower the cognitively impaired.

  14. Aetiology of cognitive impairment in children with frontal lobe epilepsy.

    PubMed

    Braakman, H M H; Vaessen, M J; Jansen, J F A; Debeij-van Hall, M H J A; de Louw, A; Hofman, P A M; Vles, J S H; Aldenkamp, A P; Backes, W H

    2015-01-01

    Cognitive impairment is frequent in children with frontal lobe epilepsy (FLE), but its aetiology is unknown. MRI scans often reveal no structural brain abnormalities that could explain the cognitive impairment. This does not exclude more subtle morphological abnormalities that can only be detected by automated morphometric techniques. With these techniques, we investigate the relationship between cortical brain morphology and cognitive functioning in a cohort of children with FLE and healthy controls. Thirty-four children aged 8-13 years with FLE of unknown cause and 41 healthy age-matched controls underwent neuropsychological assessment and structural brain MRI. Patients were grouped as cognitively impaired or unimpaired. Intracranial volume, white matter volume, lobular cortical volume, cortical thickness and volumes of cortex structures were compared between patients and controls, and potential correlations with cognitive status were determined. The group of cognitively impaired children with FLE had significantly smaller left temporal cortex volumes, specifically middle temporal grey matter volume and entorhinal cortex thickness. In addition, cognitively impaired children with FLE had smaller volumes of structures in the left and right frontal cortex, right temporal cortex and the left subcortical area. Cognitively impaired children with FLE have smaller volumes of various cortex structures within the frontal lobes and in extra-frontal regions, most notably temporal cortex volumes. These findings might well explain the broad scale of cognitive domains affected in children with FLE complicated by cognitive impairment and highlight that FLE impacts on areas beyond the frontal lobe. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Mediterranean Diet and Mild Cognitive Impairment

    PubMed Central

    Scarmeas, Nikolaos; Stern, Yaakov; Mayeux, Richard; Manly, Jennifer; Schupf, Nicole; Luchsinger, Jose A.

    2009-01-01

    Background Higher adherence to the Mediterranean diet (MeDi) may protect from Alzheimer’s disease (AD) but its association with Mild Cognitive Impairment (MCI) has not been explored. Objective To investigate the association between MeDi and MCI. Design, Setting, Patients, Outcomes In a multiethnic community study in New York, we used Cox proportional hazards to investigate the association between adherence to the MeDi (0 – 9 scale; higher scores higher adherence) and (1) incidence of MCI and (2) progression from MCI to AD. All models were adjusted for cohort, age, gender, ethnicity, education, APOE genotype, caloric intake, body mass index and time duration between baseline dietary assessment and baseline diagnosis. Results There were 1393 cognitively normal participants, 275 of whom developed MCI during 4.5 (± 2.7, 0.9–16.4) years of follow-up. Compared to subjects in the lowest MeDi adherence tertile, subjects in the middle MeDi tertile had 17 % (HR, 0.83; 95% CI, 0.62 – 1.12; p=0.24) less risk of developing MCI, while those at the highest MeDi adherence tertile had 28 % (HR, 0.72; 95% CI, 0.52 – 1.00; p=0.05) less risk of developing MCI (trend HR, 0.85; 95% CI, 0.72 – 1.00; p for trend= 0.05). There were 482 subjects with MCI, 106 of whom developed AD during 4.3 (± 2.7, 1.0 – 13.8) years of follow-up. Compared to subjects in the lowest MeDi adherence tertile, subjects in the middle MeDi adherence tertile had 45 % (HR, 0.55; 95% CI, 0.34 – 0.90; p=0.01) less risk of developing AD, while those at the highest MeDi adherence tertile had 48 % (HR, 0.52; 95% CI, 0.30 – 0.91; p=0.02) less risk of developing AD (trend HR, 0.71; 95% CI, 0.53 – 0.95; p for trend= 0.02). Conclusions Higher adherence to the MeDi is associated with a trend for reduced risk for developing MCI and with reduced risk for MCI conversion to AD. PMID:19204158

  16. Selective impairment of auditory selective attention under concurrent cognitive load.

    PubMed

    Dittrich, Kerstin; Stahl, Christoph

    2012-06-01

    Load theory predicts that concurrent cognitive load impairs selective attention. For visual stimuli, it has been shown that this impairment can be selective: Distraction was specifically increased when the stimulus material used in the cognitive load task matches that of the selective attention task. Here, we report four experiments that demonstrate such selective load effects for auditory selective attention. The effect of two different cognitive load tasks on two different auditory Stroop tasks was examined, and selective load effects were observed: Interference in a nonverbal-auditory Stroop task was increased under concurrent nonverbal-auditory cognitive load (compared with a no-load condition), but not under concurrent verbal-auditory cognitive load. By contrast, interference in a verbal-auditory Stroop task was increased under concurrent verbal-auditory cognitive load but not under nonverbal-auditory cognitive load. This double-dissociation pattern suggests the existence of different and separable verbal and nonverbal processing resources in the auditory domain.

  17. Homelessness and Cognitive Impairment: An Exploratory Study in Tokyo, Japan.

    PubMed

    Pluck, G; Nakakarumai, M; Sato, Y

    2015-09-01

    Homelessness has frequently been associated with neuropsychological impairment. This has been observed using general screening tests for dementia as well as tests of more focal abilities, particularly executive function. Most studies have been of homeless individuals from North America with none reported from Japan. In this exploratory study we interviewed a sample of 16 homeless adults from Tokyo, Japan, and performed tests of cognitive function, assessed head injury, addictive behaviours (drug use, gambling, alcohol abuse), and recorded details of homelessness history. The cognitive examination involved the Japanese Adult Reading Test to estimate premorbid intelligence quotient, the Wisconsin Card Sorting Test to measure frontal lobe-related cognitive function, and the Mini-Mental State Examination to measure global cognitive impairment associated with dementia. Among the 16 homeless individuals, 7 (44%) displayed global cognitive impairment. In addition, executive function tended to be poor. In contrast, estimated premorbid intelligence quotient was within the normal range. Substance abuse in general was not at a level to cause clinical concern, although a high level of pathological gambling was observed. There were no associations between cognitive function and clinical and addictive behaviour variables, although associations were noted between cognitive scores and time spent homeless. The results suggest high levels of neuropsychological impairment in this sample of homeless adults in Japan. Furthermore, cognitive impairment is acquired rather than developmental in origin, and is proportional to the length of time spent homeless.

  18. Amyloid imaging in mild cognitive impairment subtypes.

    PubMed

    Wolk, David A; Price, Julie C; Saxton, Judy A; Snitz, Beth E; James, Jeffrey A; Lopez, Oscar L; Aizenstein, Howard J; Cohen, Ann D; Weissfeld, Lisa A; Mathis, Chester A; Klunk, William E; De-Kosky, Steven T; DeKoskym, Steven T

    2009-05-01

    We utilized the amyloid imaging ligand Pittsburgh Compound B (PiB) to determine the presence of Alzheimer's disease (AD) pathology in different mild cognitive impairment (MCI) subtypes and to relate increased PiB binding to other markers of early AD and longitudinal outcome. Twenty-six patients with MCI (13 single-domain amnestic-MCI [a-MCI], 6 multidomain a-MCI, and 7 nonamnestic MCI) underwent PiB imaging. Twenty-three had clinical follow-up (21.2 +/- 16.0 [standard deviation] months) subsequent to their PiB scan. Using cutoffs established from a control cohort, we found that 14 (54%) patients had increased levels of PiB retention and were considered "amyloid-positive." All subtypes were associated with a significant proportion of amyloid-positive patients (6/13 single-domain a-MCI, 5/6 multidomain a-MCI, 3/7 nonamnestic MCI). There were no obvious differences in the distribution of PiB retention in the nonamnestic MCI group. Predictors of conversion to clinical AD in a-MCI, including poorer episodic memory, and medial temporal atrophy, were found in the amyloid-positive relative to amyloid-negative a-MCI patients. Longitudinal follow-up demonstrated 5 of 13 amyloid-positive patients, but 0 of 10 amyloid-negative patients, converted to clinical AD. Further, 3 of 10 amyloid-negative patients "reverted to normal." These data support the notion that amyloid-positive patients are likely to have early AD, and that the use of amyloid imaging may have an important role in determining which patients are likely to benefit from disease-specific therapies. In addition, our data are consistent with longitudinal studies that suggest a significant percentage of all MCI subtypes will develop AD.

  19. [Cognitive impairment in elderly patients with acute hypertensive encephalopathy].

    PubMed

    Baev, V M; Kozlov, D B

    2012-01-01

    Acute hypertensive encephalopathy in elderly patients appears reversible mild cognitive impairment. The erythrocyte sedimentation rate and blood creatinine measured during a hypertensive crisis are predictors of decline of visual-spatial orientation after two weeks of treatment.

  20. [Cryptococcal meningoencephalitis presenting with treatable cognitive impairment and involuntary movement].

    PubMed

    Ikumi, Kazuhiro; Yokoi, Katsunori; Ando, Tetsuo

    2016-01-01

    The patient is a 72-year-old Japanese woman. Seven years prior to admission, multiple nodules in her left lung were found. Bronchoscopic biopsy of the nodules did not provide a confirmative diagnosis, and probable diagnosis of cryptococcosis was made. Follow-up CT scan of the chest revealed reduction in size of the lung nodules. She was admitted to our hospital due to progressive cognitive impairment and difficulty in walking that lasted for 5 months. On admission, athetotic involuntary movement was observed in her lower extremities, predominantly in the right side. Blood and cerebrospinal fluid culture of the patient were positive for Cryptococcus neoformans. Antifungal drugs resolved the cognitive impairment, the difficulty in walking, and the involuntary movement. We assessed the cognitive impairment and observed the clinical improvement of the patient, with the use of neuropsychological examinations. To our knowledge, there has been only a few reported case of cryptococcal meningoencephalitis presenting with treatable cognitive impairment and involuntary movement.

  1. [Neurophysiology and ageing. Definition and pathophysiological foundations of cognitive impairment].

    PubMed

    Borrás Blasco, Consuelo; Viña Ribes, José

    2016-06-01

    Brain ageing is produced by various morphological, biochemical, metabolic and circulatory changes, which are reflected in functional changes, whose impact depends on the presence or absence of cognitive impairment. Because of brain plasticity, together with redundancy of the distinct cerebral circuits, age- related deterioration of the brain at various levels does not always translate into loss of brain function. However, when the damage exceeds certain thresholds, there is age-related cognitive impairment, which increases the risk of developing various neurodegenerative diseases such as Alzheimer disease. Genetics, together with lifestyle, diet, and environmental factors, etc, can trigger the development of these diseases, which provoke cognitive impairment. This article discusses the most important age-related changes in the brain, as well as the pathophysiological foundations of cognitive impairment.

  2. Memory complaints in subjective cognitive impairment, amnestic mild cognitive impairment and mild Alzheimer's disease.

    PubMed

    Ryu, Seon Young; Lee, Sang Bong; Kim, Tae Woo; Lee, Taek Jun

    2016-12-01

    Memory complaints are a frequent phenomenon in elderly individuals and can lead to opportunistic help-seeking behavior. The aim of this study was to compare different aspects of memory complaints (i.e., prospective versus retrospective complaints) in individuals with subjective cognitive impairment (SCI), amnestic mild cognitive impairment (aMCI), and mild Alzheimer's disease (AD). The study included a total of 115 participants (mean age: 68.82 ± 8.83 years) with SCI (n = 34), aMCI (n = 46), and mild AD (n = 35). Memory complaints were assessed using the Prospective and Retrospective Memory Questionnaire (PRMQ), which consists of 16 items that describe everyday memory failure of both prospective memory (PM) and retrospective memory (RM). For aMCI and AD subjects, informants also completed an informant-rating of the PRMQ. All participants completed detailed neuropsychological tests. Results show that PM complaints were equivalent among the three groups. However, RM complaints differed. Specifically, RM complaints in aMCI were higher than SCI, but similar to AD. Informant-reported memory complaints were higher for AD than aMCI. Our study suggests that RM complaints of memory complaints may be helpful in discriminating between SCI and aMCI, but both PM and RM complaints are of limited value in differentiating aMCI from AD.

  3. Molecular imaging of serotonin degeneration in mild cognitive impairment.

    PubMed

    Smith, Gwenn S; Barrett, Frederick S; Joo, Jin Hui; Nassery, Najlla; Savonenko, Alena; Sodums, Devin J; Marano, Christopher M; Munro, Cynthia A; Brandt, Jason; Kraut, Michael A; Zhou, Yun; Wong, Dean F; Workman, Clifford I

    2017-09-01

    Neuropathological and neuroimaging studies have consistently demonstrated degeneration of monoamine systems, especially the serotonin system, in normal aging and Alzheimer's disease. The evidence for degeneration of the serotonin system in mild cognitive impairment is limited. Thus, the goal of the present study was to measure the serotonin transporter in vivo in mild cognitive impairment and healthy controls. The serotonin transporter is a selective marker of serotonin terminals and of the integrity of serotonin projections to cortical, subcortical and limbic regions and is found in high concentrations in the serotonergic cell bodies of origin of these projections (raphe nuclei). Twenty-eight participants with mild cognitive impairment (age 66.6±6.9, 16 males) and 28 healthy, cognitively normal, demographically matched controls (age 66.2±7.1, 15 males) underwent magnetic resonance imaging for measurement of grey matter volumes and high-resolution positron emission tomography with well-established radiotracers for the serotonin transporter and regional cerebral blood flow. Beta-amyloid imaging was performed to evaluate, in combination with the neuropsychological testing, the likelihood of subsequent cognitive decline in the participants with mild cognitive impairment. The following hypotheses were tested: 1) the serotonin transporter would be lower in mild cognitive impairment compared to controls in cortical and limbic regions, 2) in mild cognitive impairment relative to controls, the serotonin transporter would be lower to a greater extent and observed in a more widespread pattern than lower grey matter volumes or lower regional cerebral blood flow and 3) lower cortical and limbic serotonin transporters would be correlated with greater deficits in auditory-verbal and visual-spatial memory in mild cognitive impairment, not in controls. Reduced serotonin transporter availability was observed in mild cognitive impairment compared to controls in cortical and limbic

  4. Clinical differences among mild cognitive impairment subtypes in Parkinson's disease.

    PubMed

    Goldman, Jennifer G; Weis, Holly; Stebbins, Glenn; Bernard, Bryan; Goetz, Christopher G

    2012-08-01

    Mild cognitive impairment is increasingly recognized as a construct in Parkinson's disease (PD) and occurs in about 25% of nondemented PD patients. Although executive dysfunction is the most frequent type of cognitive deficit in PD, the cognitive phenotype of PD mild cognitive impairment (PD-MCI) is broad. PD-MCI subtypes are represented by amnestic and nonamnestic domain impairment as well as single- and multiple-domain impairment. However, it is unclear whether patients with different PD-MCI subtypes also differ in other clinical characteristics in addition to cognitive profile. We studied 128 PD-MCI subjects at our Movement Disorders center, comparing clinical, motor, and behavioral characteristics across the PD-MCI subtypes. We found varying proportions of impairment subtypes: nonamnestic single domain, 47.7%; amnestic multiple domain, 24.2%; amnestic single domain, 18.8%; and nonamnestic multiple domain, 9.5%. Attentional/executive functioning and visuospatial abilities were the most frequently impaired domains. PD-MCI subtypes differed in their motor features, with nonamnestic multiple-domain PD-MCI subjects showing particularly pronounced problems with postural instability and gait. Differences among PD-MCI subtypes in age, PD duration, medication use, mood or behavioral disturbances, and vascular disease were not significant. Thus, in addition to differing cognitive profiles, PD-MCI subtypes differed in motor phenotype and severity but not in mood, behavioral, or vascular comorbidities. Greater postural instability and gait disturbances in the nonamnestic multiple-domain subtype emphasize shared nondopaminergic neural substrates of gait and cognition in PD. Furthermore, increased burden of cognitive dysfunction, rather than type of cognitive deficit, may be associated with greater motor impairment in PD-MCI.

  5. Care mapping in clinical neuroscience settings: Cognitive impairment and dependency.

    PubMed

    Leigh, Andrew James; O'Hanlon, Katie; Sheldrick, Russell; Surr, Claire; Hare, Dougal Julian

    2015-01-01

    Person-centred care can improve the well-being of patients and is therefore a key driver in healthcare developments in the UK. The current study aims to investigate the complex relationship between cognitive impairment, dependency and well-being in people with a wide range of acquired brain and spinal injuries. Sixty-five participants, with varied acquired brain and spinal injuries, were selected by convenience sampling from six inpatient clinical neuroscience settings. Participants were observed using Dementia Care Mapping - Neurorehabilitation (DCM-NR) and categorised based on severity of cognitive impairment. A significant difference in the behaviours participants engaged in, their well-being and dependency was found between the severe cognitive impairment group and the mild, moderate or no cognitive impairment groups. Dependency and cognitive impairment accounted for 23.9% of the variance in well-ill-being scores and 17.2% of the variance in potential for positive engagement. The current study highlights the impact of severe cognitive impairment and dependency on the behaviours patients engaged in and their well-being. It also affirms the utility of DCM-NR in providing insights into patient experience. Consideration is given to developing DCM-NR as a process that may improve person-centred care in neuroscience settings.

  6. Biomarkers for dementia and mild cognitive impairment in Parkinson's disease.

    PubMed

    Delgado-Alvarado, Manuel; Gago, Belén; Navalpotro-Gomez, Irene; Jiménez-Urbieta, Haritz; Rodriguez-Oroz, María C

    2016-06-01

    Cognitive decline is one of the most frequent and disabling nonmotor features of Parkinson's disease. Around 30% of patients with Parkinson's disease experience mild cognitive impairment, a well-established risk factor for the development of dementia. However, mild cognitive impairment in patients with Parkinson's disease is a heterogeneous entity that involves different types and extents of cognitive deficits. Because it is not currently known which type of mild cognitive impairment confers a higher risk of progression to dementia, it would be useful to define biomarkers that could identify these patients to better study disease progression and possible interventions. In this sense, the identification among patients with Parkinson's disease and mild cognitive impairment of biomarkers associated with dementia would allow the early detection of this process. This review summarizes studies from the past 25 years that have assessed the potential biomarkers of dementia and mild cognitive impairment in Parkinson's disease patients. Despite the potential importance, no biomarker has as yet been validated. However, features such as low levels of epidermal and insulin-like growth factors or uric acid in plasma/serum and of Aß in CSF, reduction of cerebral cholinergic innervation and metabolism measured by PET mainly in posterior areas, and hippocampal atrophy in MRI might be indicative of distinct deficits with a distinct risk of dementia in subgroups of patients. Longitudinal studies combining the existing techniques and new approaches are needed to identify patients at higher risk of dementia. © 2016 International Parkinson and Movement Disorder Society.

  7. Increased matrix metalloproteinase 9 activity in mild cognitive impairment.

    PubMed

    Bruno, Martin A; Mufson, Elliott J; Wuu, Joanne; Cuello, A Claudio

    2009-12-01

    Nerve growth factor (NGF)-dependent cholinergic basal forebrain neurons degenerate during the progression of Alzheimer disease (AD). Elevated proNGF and reduced levels of the TrkA high-affinity NGF receptor occur in prodromal and advanced stages of AD. We recently described a protease cascade responsible for the conversion of proNGF to mature NGF (mNGF) in which matrix metalloproteinase 9 (MMP-9) degrades mNGF in the extracellular space. To determine whether this proteolytic cascade is altered during the progression of AD, we examined human frontal and parietal cortex tissues from aged subjects with a clinical diagnosis of AD, mild cognitive impairment, or no cognitive impairment. The analysis demonstrated greater MMP-9 activity in both AD and mild cognitive impairment compared with no cognitive impairment brain samples (p < 0.01), which supports the notion that a metabolic failure in the NGF-maturation/degradation pathway may be associated with an exacerbated degradation of mNGF in the cerebral cortex in early AD. Moreover, there were inverse correlations between Global Cognitive Score and Mini-Mental State Examination score and MMP-9 activity. These findings suggest that a reduction in mNGF as a consequence of MMP-9-mediated degradation may in part underlie the pathogenesis of cognitive deficits in mild cognitive impairment and AD.

  8. Developmental Dyscalculia in Adults: Beyond Numerical Magnitude Impairment.

    PubMed

    De Visscher, Alice; Noël, Marie-Pascale; Pesenti, Mauro; Dormal, Valérie

    2017-09-01

    Numerous studies have tried to identify the core deficit of developmental dyscalculia (DD), mainly by assessing a possible deficit of the mental representation of numerical magnitude. Research in healthy adults has shown that numerosity, duration, and space share a partly common system of magnitude processing and representation. However, in DD, numerosity processing has until now received much more attention than the processing of other non-numerical magnitudes. To assess whether or not the processing of non-numerical magnitudes is impaired in DD, the performance of 15 adults with DD and 15 control participants was compared in four categorization tasks using numerosities, lengths, durations, and faces (as non-magnitude-based control stimuli). Results showed that adults with DD were impaired in processing numerosity and duration, while their performance in length and face categorization did not differ from controls' performance. Our findings support the idea of a nonsymbolic magnitude deficit in DD, affecting numerosity and duration processing but not length processing.

  9. Glycogen synthase kinase-3 inhibitors: Rescuers of cognitive impairments

    PubMed Central

    King, Margaret K.; Pardo, Marta; Cheng, Yuyan; Downey, Kimberlee; Jope, Richard S.; Beurel, Eléonore

    2013-01-01

    Impairment of cognitive processes is a devastating outcome of many diseases, injuries, and drugs affecting the central nervous system (CNS). Most often, very little can be done by available therapeutic interventions to improve cognitive functions. Here we review evidence that inhibition of glycogen synthase kinase-3 (GSK3) ameliorates cognitive deficits in a wide variety of animal models of CNS diseases, including Alzheimer's disease, Fragile X syndrome, Down syndrome, Parkinson's disease, spinocerebellar ataxia type 1, traumatic brain injury, and others. GSK3 inhibitors also improve cognition following impairments caused by therapeutic interventions, such as cranial irradiation for brain tumors. These findings demonstrate that GSK3 inhibitors are able to ameliorate cognitive impairments caused by a diverse array of diseases, injury, and treatments. The improvements in impaired cognition instilled by administration of GSK3 inhibitors appear to involve a variety of different mechanisms, such as supporting long-term potentiation and diminishing long-term depression, promotion of neurogenesis, reduction of inflammation, and increasing a number of neuroprotective mechanisms. The potential for GSK3 inhibitors to repair cognitive deficits associated with many conditions warrants further investigation of their potential for therapeutic interventions, particularly considering the current dearth of treatments available to reduce loss of cognitive functions. PMID:23916593

  10. Adapting Homework for an Older Adult Client with Cognitive Impairment

    ERIC Educational Resources Information Center

    Coon, David W.; Thompson, Larry W.; Gallagher-Thompson, Dolores

    2007-01-01

    There is growing evidence that psychosocial treatments incorporating behavioral intervention strategies can be effective in the treatment of depression in older adults with cognitive impairment. However, less work with such cases has focused on the use of cognitive interventions in tandem with these behavioral intervention strategies. This case…

  11. Auditory Processing of Older Adults with Probable Mild Cognitive Impairment

    ERIC Educational Resources Information Center

    Edwards, Jerri D.; Lister, Jennifer J.; Elias, Maya N.; Tetlow, Amber M.; Sardina, Angela L.; Sadeq, Nasreen A.; Brandino, Amanda D.; Bush, Aryn L. Harrison

    2017-01-01

    Purpose: Studies suggest that deficits in auditory processing predict cognitive decline and dementia, but those studies included limited measures of auditory processing. The purpose of this study was to compare older adults with and without probable mild cognitive impairment (MCI) across two domains of auditory processing (auditory performance in…

  12. Non-Linguistic Cognitive Treatment for Primary Language Impairment

    ERIC Educational Resources Information Center

    Ebert, Kerry Danahy; Kohnert, Kathryn

    2009-01-01

    Children with primary or "specific" language impairment (PLI) demonstrate subtle deficits in non-linguistic cognitive processing skills that may play a causal or contributing role in PLI. The purpose of this study was to investigate the possibility that short-term treatment of non-linguistic cognitive processing skills improves language abilities…

  13. Adapting Homework for an Older Adult Client with Cognitive Impairment

    ERIC Educational Resources Information Center

    Coon, David W.; Thompson, Larry W.; Gallagher-Thompson, Dolores

    2007-01-01

    There is growing evidence that psychosocial treatments incorporating behavioral intervention strategies can be effective in the treatment of depression in older adults with cognitive impairment. However, less work with such cases has focused on the use of cognitive interventions in tandem with these behavioral intervention strategies. This case…

  14. [Effect of anticholinergic drugs on cognitive impairment in the elderly].

    PubMed

    López-Álvarez, Jorge; Zea Sevilla, María Ascensión; Agüera Ortiz, Luis; Fernández Blázquez, Miguel Ángel; Valentí Soler, Meritxell; Martínez-Martín, Pablo

    2015-01-01

    The use of anticholinergic drugs is common in the elderly, even in people with cognitive impairment. A systematic search was conducted in PubMed (anticholinergic effects, anticholinergic and dementia) to define the effects of anticholinergic drugs in the elderly. We emphasized the search in patterns of use, the combined use with AChEIs, the measurement of the Serum Anticholinergic Activity, and the short-term and long-term cognitive effects. The conclusions are that the use of anticholinergic drugs is common in the elderly, even more so than the medical prescription of AChEIs in Alzheimer's disease. The use of anticholinergic drugs may result in cognitive impairment. In long-term use it may generate a worsening of cognitive functions. It can lead to a wrong diagnosis of mild cognitive impairment or dementia, and they can also initiate signs of dementia. Greater cognitive effects appear when there is a previous deficit, but cognitive effects from anticholinergic drugs disappear in severe dementia. The presence of ApoEɛ4 increases the vulnerability for cognitive impairment when these drugs are employed.

  15. Acute stress impairs cognitive flexibility in men, not women.

    PubMed

    Shields, Grant S; Trainor, Brian C; Lam, Jovian C W; Yonelinas, Andrew P

    2016-09-01

    Psychosocial stress influences cognitive abilities, such as long-term memory retrieval. However, less is known about the effects of stress on cognitive flexibility, which is mediated by different neurobiological circuits and could thus be regulated by different neuroendocrine pathways. In this study, we randomly assigned healthy adults to an acute stress induction or control condition and subsequently assessed participants' cognitive flexibility using an open-source version of the Wisconsin Card Sort task. Drawing on work in rodents, we hypothesized that stress would have stronger impairing effects on cognitive flexibility in men than women. As predicted, we found that stress impaired cognitive flexibility in men but did not significantly affect women. Our results thus indicate that stress exerts sex-specific effects on cognitive flexibility in humans and add to the growing body of research highlighting the need to consider sex differences in effects of stress.

  16. Computational cognitive modeling for the diagnosis of Specific Language Impairment.

    PubMed

    Oliva, Jesus; Serrano, J Ignacio; del Castillo, M Dolores; Iglesias, Angel

    2013-01-01

    Specific Language Impairment (SLI), as many other cognitive deficits, is difficult to diagnose given its heterogeneous profile and its overlap with other impairments. Existing techniques are based on different criteria using behavioral variables on different tasks. In this paper we propose a methodology for the diagnosis of SLI that uses computational cognitive modeling in order to capture the internal mechanisms of the normal and impaired brain. We show that machine learning techniques that use the information of these models perform better than those that only use behavioral variables.

  17. CSF proteomic fingerprints for HIV- associated cognitive impairment

    PubMed Central

    Laspiur, Juliana Pérez; Anderson, Eric R.; Ciborowski, Pawel; Wojna, Valerie; Rozek, Wojciech; Duan, Fenghai; Mayo, Raul; Rodríguez, Elaine; Plaud-Valentín, Marinés; Rodríguez-Orengo, José; Gendelman, Howard E.; Meléndez, Loyda M.

    2008-01-01

    Cognitive impairment remains a major complication of advanced human immunodeficiency virus (HIV) infection despite the wide spread use of anti-retroviral therapy. Diagnosis is made by exclusion making biomarkers of great potential use. Thus, we used an integrated proteomics platform to assess cerebrospinal fluid protein profiles from 50 HIV-1 seropositive Hispanic women. Nine of 38 proteins identified were unique in those patients with cognitive impairment. These proteins were linked to cell signaling, structural function, and antioxidant activities. This work highlights, in a preliminary manner, the utility of proteomic profiling for biomarker discovery for HIV-1 associated cognitive dysfunction. PMID:17950469

  18. Cognitive Reserve Moderates the Association between Heart Failure and Cognitive Impairment

    PubMed Central

    Alosco, Michael L.; Spitznagel, Mary Beth; Raz, Naftali; Cohen, Ronald; Sweet, Lawrence H.; van Dulmen, Manfred; Colbert, Lisa H.; Josephson, Richard; Waechter, Donna; Hughes, Joel; Rosneck, Jim; Gunstad, John

    2016-01-01

    Background Cognitive impairment in persons with heart failure is common. Theories of cognitive reserve suggest that premorbid factors, such as intellectual ability, may provide a buffer against cognitive impairment due to neuropathological insult. No study has examined the influence of cognitive reserve on cognitive functioning in older adults with heart failure. Aim This study examined whether cognitive reserve moderates the relationship between heart failure severity and cognitive function. Methods A total of 157 persons with heart failure (69.26 ± 9.26 years; 39% female) completed neuropsychological testing and a brief fitness assessment. Cognitive reserve was operationalized using estimated premorbid intellect on American National Adult Reading Test (AMNART). Results A moderation analysis was performed using a hierarchical regression models for each cognitive domain. An interaction term between the AMNART and 2-minute step test was created and entered into the final block of the model, with demographic, psychosocial, and heart failure severity entered in the previous blocks. The interaction term was significant for attention (t(155) = −2.54, p = .012), executive function (t(155) = −3.30, p = .001), and language (t(155) = −2.83, p = .005) domains. Conclusion The current findings suggest that cognitive reserve moderates the association between heart failure severity and cognitive function in multiple cognitive domains. Further work is needed to clarify the mechanisms by which cognitive reserve attenuates cognitive impairment in this population. PMID:22034987

  19. [Does pre-surgical cognitive impairment affect knee replacement results?].

    PubMed

    Jiménez, M; Zorrilla, P; López-Alonso, A; León, A; Salido, J A

    2014-01-01

    To determine the influence of the pre-operative cognitive impairment on results of the total knee arthroplasty according to a doctor and patient perspective. A prospective study was conducted on patient from the surgical waiting list who had undergone a primary total knee arthroplasty. The sample initially included 265 patients, but 50 were subsequently excluded. Cognitive impairment was assessed pre-operatively by the Mini Cognitive Examination (MEC-35). The Visual Analog Scale (VAS), the Knee Society Score (KSS), the Western Ontario and McMaster Osteoarthritis Index (WOMAC), and the Hospital Anxiety and Depression Scale (HADS), were used pre-operatively and one year later post-operatively. A total of 215 patients were assessed (57 men and 158 women). Cognitive impairment had no influence on the results of total knee arthroplasty. In fact, there was no statistical significance in any of the scales analyzed. Preoperatively, and one year later, the patients with cognitive impairment showed higher levels of anxiety and depression, with these differences being statistically significant. All of the patients experienced an improvement in the specific outcomes and quality of life after the total knee arthroplasty procedure, regardless of the presence of preoperative cognitive impairment. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  20. Early Detection of Cognitive-Linguistic Change Associated with Mild Cognitive Impairment

    ERIC Educational Resources Information Center

    Fleming, Valarie B.

    2014-01-01

    Individuals with mild cognitive impairment (MCI) may present with subtle declines in linguistic ability that go undetected by tasks not challenging enough to tax a relatively intact cognitive-linguistic system. This study was designed to replicate and extend a previous study of cognitive-linguistic ability in MCI using a complex discourse…

  1. Early Detection of Cognitive-Linguistic Change Associated with Mild Cognitive Impairment

    ERIC Educational Resources Information Center

    Fleming, Valarie B.

    2014-01-01

    Individuals with mild cognitive impairment (MCI) may present with subtle declines in linguistic ability that go undetected by tasks not challenging enough to tax a relatively intact cognitive-linguistic system. This study was designed to replicate and extend a previous study of cognitive-linguistic ability in MCI using a complex discourse…

  2. Parkinson disease and cognitive impairment: Five new things.

    PubMed

    Davis, Albert A; Racette, Brad

    2016-10-01

    While the distinctive motor symptoms of Parkinson disease (PD) have been described for centuries, cognitive impairment has only recently been recognized as a central feature. Studies have yielded clues to the etiology and natural history of cognitive impairment in PD, but much remains unclear and effective therapies are needed. Longitudinal cohort studies demonstrate that almost all patients with PD will develop dementia if they live long enough. New CSF biomarker and genetic studies suggest that it may soon be possible to forecast and track the progression of dementia in PD. Sleep and sleep disturbance appear to be intrinsically linked with PD, although the implications for individual outcomes and opportunities for intervention are unclear. Multidisciplinary treatment approaches incorporating cognitive training may help to improve outcomes. We review several recent advances in understanding the pathophysiology, genetics, and management of cognitive impairment in PD.

  3. Cognitive impairment in patients with chronic fatigue: a preliminary study.

    PubMed Central

    McDonald, E; Cope, H; David, A

    1993-01-01

    Subjective impairment of memory and concentration is a frequent complaint in sufferers from chronic fatigue. To study this, 65 general practice attenders identified as having chronic fatigue were administered a structured psychiatric interview and a brief screening battery of cognitive tests. Subjective cognitive impairment was strongly related to psychiatric disorder, especially depressed mood, but not fatigue, anxiety, or objective performance. Simple tests of attention and concentration showed some impairment but this was influenced by both fatigue and depression. Subjects with high levels of fatigue performed less well on a memory task requiring cognitive effort, even in the absence of depression. There was no evidence for mental fatiguability. The relationship between depression, fatigue, and cognitive function requires further research. PMID:8331359

  4. Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies

    PubMed Central

    Solé, Brisa; Jiménez, Esther; Torrent, Carla; Reinares, Maria; Bonnin, Caterina del Mar; Torres, Imma; Varo, Cristina; Grande, Iria; Valls, Elia; Salagre, Estela; Sanchez-Moreno, Jose; Martinez-Aran, Anabel; Carvalho, André F

    2017-01-01

    Abstract Over the last decade, there has been a growing appreciation of the importance of identifying and treating cognitive impairment associated with bipolar disorder, since it persists in remission periods. Evidence indicates that neurocognitive dysfunction may significantly influence patients’ psychosocial outcomes. An ever-increasing body of research seeks to achieve a better understanding of potential moderators contributing to cognitive impairment in bipolar disorder in order to develop prevention strategies and effective treatments. This review provides an overview of the available data from studies examining treatments for cognitive dysfunction in bipolar disorder as well as potential novel treatments, from both pharmacological and psychological perspectives. All these data encourage the development of further studies to find effective strategies to prevent and treat cognitive impairment associated with bipolar disorder. These efforts may ultimately lead to an improvement of psychosocial functioning in these patients. PMID:28498954

  5. Measuring hope among families impacted by cognitive impairment.

    PubMed

    Hunsaker, Amanda E; Terhorst, Lauren; Gentry, Amanda; Lingler, Jennifer H

    2016-07-01

    The current exploratory investigation aims to establish the reliability and validity of a hope measure, the Herth Hope Index, among families impacted by early cognitive impairment (N = 96). Exploratory factor analysis was used to examine the dimensionality of the measure. Bivariate analyses were used to examine construct validity. The sample had moderately high hope scores. A two-factor structure emerged from the factor analysis, explaining 51.44% of the variance. Both factors exhibited strong internal consistency (Cronbach's alphas ranged from .83 to .86). Satisfaction with social support was positively associated with hope, supporting convergent validity. Neurocognitive status, illness insight, and depression were not associated with hope, indicating discriminant validity. Families impacted by cognitive impairment may maintain hope in the face of a potentially progressive illness, regardless of cognitive status. The Herth Hope Index can be utilized as a reliable and valid measure of hope by practitioners providing support to families impacted by cognitive impairment.

  6. The spectrum of cognitive impairment in Lewy body diseases

    PubMed Central

    Goldman, Jennifer G.; Williams-Gray, Caroline; Barker, Roger A.; Duda, John E.; Galvin, James E.

    2014-01-01

    Cognitive impairment represents an important and often defining component of the clinical syndromes of Lewy body disorders: Parkinson’s disease and dementia with Lewy bodies. The spectrum of cognitive deficits in these Lewy body diseases encompasses a broad range of clinical features, severity of impairment, and timing of presentation. Cognitive dysfunction is now recognized to occur not only in more advanced Parkinson’s disease, but also in early, untreated patients, and even in those patients with pre-motor syndromes such as REM behavior disorder and hyposmia. In recent years, the concept of “mild cognitive impairment” as a transitional or pre-dementia state in Parkinson’s disease has emerged. While this has led to much research regarding the diagnosis, prognosis, and underlying neurobiology of mild cognitive impairment in Parkinson’s disease, it has also raised questions regarding the usefulness of this concept and its application in clinical and research settings. In addition, the conundrum of whether Parkinson’s disease dementia and dementia with Lewy bodies represent the same or different entities remains unresolved. While these disorders overlap in many aspects of their presentations and pathophysiology, they differ in other aspects such as timing of cognitive, behavioral, and motor symptoms, medication responses, and neuropathological contributions. This article examines the spectrum and evolution of cognitive impairment in Lewy body disorders and debates these controversial issues in the field using point-counterpoint approaches. PMID:24757110

  7. Cognitive impairment and vitamin B12: a review.

    PubMed

    Moore, Eileen; Mander, Alastair; Ames, David; Carne, Ross; Sanders, Kerrie; Watters, David

    2012-04-01

    This review examines the associations between low vitamin B12 levels, neurodegenerative disease, and cognitive impairment. The potential impact of comorbidities and medications associated with vitamin B12 derangements were also investigated. In addition, we reviewed the evidence as to whether vitamin B12 therapy is efficacious for cognitive impairment and dementia. A systematic literature search identified 43 studies investigating the association of vitamin B12 and cognitive impairment or dementia. Seventeen studies reported on the efficacy of vitamin B12 therapy for these conditions. Vitamin B12 levels in the subclinical low-normal range (<250 ρmol/L) are associated with Alzheimer's disease, vascular dementia, and Parkinson's disease. Vegetarianism and metformin use contribute to depressed vitamin B12 levels and may independently increase the risk for cognitive impairment. Vitamin B12 deficiency (<150 ρmol/L) is associated with cognitive impairment. Vitamin B12 supplements administered orally or parenterally at high dose (1 mg daily) were effective in correcting biochemical deficiency, but improved cognition only in patients with pre-existing vitamin B12 deficiency (serum vitamin B12 levels <150 ρmol/L or serum homocysteine levels >19.9 μmol/L). Low serum vitamin B12 levels are associated with neurodegenerative disease and cognitive impairment. There is a small subset of dementias that are reversible with vitamin B12 therapy and this treatment is inexpensive and safe. Vitamin B12 therapy does not improve cognition in patients without pre-existing deficiency. There is a need for large, well-resourced clinical trials to close the gaps in our current understanding of the nature of the associations of vitamin B12 insufficiency and neurodegenerative disease.

  8. Retinopathy and Cognitive Impairment in Adults With CKD

    PubMed Central

    Yaffe, Kristine; Ackerson, Lynn; Hoang, Tina D.; Go, Alan S.; Maguire, Maureen G.; Ying, Gui-Shuang; Daniel, Ebenezer; Bazzano, Lydia A.; Coleman, Martha; Cohen, Debbie L.; Kusek, John W.; Ojo, Akinlolu; Seliger, Stephen; Xie, Dawei; Grunwald, Juan E.

    2014-01-01

    Background Retinal microvascular abnormalities have been associated with cognitive impairment, possibly serving as a marker of cerebral small vessel disease. This relationship has not been evaluated among persons with chronic kidney disease (CKD), a condition associated with increased risk of both retinal pathology and cognitive impairment. Study Design Cross-sectional study Setting & Participants 588 participants ≥ 52 years old with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study Predictor Retinopathy graded using the Early Treatment Diabetic Retinopathy Study severity scale and diameters of retinal vessels. Outcomes Neuropsychological battery of six cognitive tests Measurements Logistic regression models were used to evaluate the association of retinopathy, individual retinopathy features, and retinal vessel diameters with cognitive impairment (≤1 SD from the mean), and linear regression models were used to compare cognitive test scores across levels of retinopathy adjusting for age, race, sex, education, and medical comorbidities. Results The mean age of the cohort was 65.3 +/− 5.6 (SD) years; 51.9% were non-White, and 52.6% were male. The prevalence of retinopathy was 30.1% and 14.3% for cognitive impairment. Compared to those without retinopathy, participants with retinopathy had increased likelihood of cognitive impairment on executive function (35.1% vs. 11.5%; OR, 3.4; 95% CI, 2.0-6.0), attention (26.7% vs. 7.3%; OR, 3.0; 95% CI, 1.8-4.9), and naming (26.0% vs. 10.0%; OR, 2.1; 95% CI, 1.2-3.4) after multivariable adjustment. Increased level of retinopathy was also associated with lower cognitive performance on executive function and attention. Microaneurysms were associated with cognitive impairment on some domains, but there were no significant associations with other retinal measures after multivariable adjustment. Limitations Unknown temporal relationship between retinopathy and impairment. Conclusions In adults with CKD, retinopathy is

  9. Cognitive impairments and subjective cognitive complaints after survival of cardiac arrest: A prospective longitudinal cohort study.

    PubMed

    Steinbusch, Catherine V M; van Heugten, Caroline M; Rasquin, Sascha M C; Verbunt, Jeanine A; Moulaert, Véronique R M

    2017-08-14

    Cardiac arrest can lead to hypoxic brain injury, which can affect cognitive functioning. To investigate the course of objective and subjective cognitive functioning and their association during the first year after cardiac arrest. A multi-centre prospective longitudinal cohort study with one year follow-up (measurements at two weeks, three months and one year). Cognitive functioning was measured with a neuropsychological test battery and subjective cognitive functioning with the Cognitive Failures Questionnaire. 141 cardiac arrest survivors participated. Two weeks post cardiac arrest 16% to 29% of survivors were cognitively impaired varying on the different tests, at three months between 9% and 23% and at one year 10%-22% remained impaired with executive functioning being affected most. Significant reduction of cognitive impairments was seen for all tests, with most recovery during the first three months after cardiac arrest. Subjective cognitive complaints were present at two weeks after cardiac arrest in 11%, 12% at three months and 14% at one year. There were no significant associations between cognitive impairments and cognitive complaints at any time point. Cognitive impairments are common in cardiac arrest survivors with executive functioning being mostly affected. Most recovery is seen in the first three months after cardiac arrest. After one year, a substantial number of patients remain impaired, especially in executive functioning. Because of absence of associations between impairments and complaints, cognitive testing using a sensitive test battery is important and should be part of routine follow-up after a cardiac arrest. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Variability in performance: Identifying early signs of future cognitive impairment

    PubMed Central

    Gamaldo, Alyssa A.; An, Yang; Allaire, Jason C.; Kitner-Triolo, Melissa H.; Zonderman, Alan B.

    2012-01-01

    Objective The current study examined whether year-to-year variability in cognitive performance differ between individuals cognitively unimpaired and individuals who subsequently develop dementia. Method Analyses included a case-control sample of Baltimore Longitudinal Study of Aging (BLSA; M age = 69.90, SD = 8.92) participants. One hundred and thirty five clinically diagnosed demented participants were matched with 135 non-demented participants based on age at initial testing and sex. Cognitive performance was examined using measures of memory, executive function, attention, language, and global mental status performance. Cognitive performance was examined from baseline to 5 years before cognitive impairment (mean assessments = 3.03, SD = 2.80). Results Compared to unimpaired individuals, individuals diagnosed with dementia had greater variability on measures of attention, executive function, language, and semantic memory at least 5 years before the estimated onset of cognitive impairment, which may be indicative of maladaptive cognitive functioning. The dementia cases, however, had less variability on visual memory than the unimpaired group, which may suggest that these cases had more difficulty learning. Conclusions These results demonstrate that performance variability indexed over annual or biennial visits may be useful in identifying early signs of subsequent cognitive impairment. PMID:22746310

  11. The hormonal pathway to cognitive impairment in older men.

    PubMed

    Maggio, M; Dall'Aglio, E; Lauretani, F; Cattabiani, C; Ceresini, G; Caffarra, P; Valenti, G; Volpi, R; Vignali, A; Schiavi, G; Ceda, G P

    2012-01-01

    In older men there is a multiple hormonal dysregulation with a relative prevalence of catabolic hormones such as thyroid hormones and cortisol and a decline in anabolic hormones such as dehydroepiandrosterone sulphate, testosterone and insulin like growth factor 1 levels. Many studies suggest that this catabolic milieu is an important predictor of frailty and mortality in older persons. There is a close relationship between frailty and cognitive impairment with studies suggesting that development of frailty is consequence of cognitive impairment and others pointing out that physical frailty is a determinant of cognitive decline. Decline in cognitive function, typically memory, is a major symptom of dementia. The "preclinical phase" of cognitive impairment occurs many years before the onset of dementia. The identification of relevant modifiable factors, including the hormonal dysregulation, may lead to therapeutic strategies for preventing the cognitive dysfunction. There are several mechanisms by which anabolic hormones play a role in neuroprotection and neuromodulation. These hormones facilitate recovery after brain injury and attenuate the neuronal loss. In contrast, elevated thyroid hormones may increase oxidative stress and apoptosis, leading to neuronal damage or death. In this mini review we will address the relationship between low levels of anabolic hormones, changes in thyroid hormones and cognitive function in older men. Then, giving the contradictory data of the literature and the multi-factorial origin of dementia, we will introduce the hypothesis of multiple hormonal derangement as a better determinant of cognitive decline in older men.

  12. Characterization of social cognition impairment in multiple sclerosis.

    PubMed

    Neuhaus, Mireille; Bagutti, Sara; Yaldizli, Özgür; Zwahlen, Dominik; Schaub, Simeon; Frey, Bettina; Fischer-Barnicol, Bettina; Burgunder, Jean-Marc; Martory, Marie-Dominique; Pöttgen, Jana; Annoni, Jean-Marie; Penner, Iris-Katharina

    2017-09-12

    Multiple sclerosis (MS) has been associated with deficits in social cognition. However, little is known about which domains of social cognition are predominantly affected and what other factors are associated with it. 1) To characterize social cognition deficit in a group of MS outpatients. 2) To relate impairment in social cognition to overall cognitive status, depression and fatigue. Thirty-five MS patients (mean disease duration 12.9 years, median EDSS 3) and thirty-four healthy controls (HCs) were examined using the German version of the Geneva Social Cognition Scale to measure different domains of social cognition. Standard neuropsychological testing was applied to all patients and to 20 HCs. Patient-reported outcomes included questionnaires for fatigue, depression, anxiety and executive-behavioural disturbances. The mean social cognition raw score was lower in the MS patients compared to the HCs (86.5±8.7 vs. 91.2±5.9 p=0.005; d=0.6) and did not correlate with EDSS or disease duration. The difference was driven by facial affect recognition and the understanding of complex social situations (14% and 23% of patients under the cut-off, respectively). The impairment in these two tasks did not correlate with general cognitive performance or depression but with fatigue. The impairment in our group was restricted to high order and affective social cognition tasks and independent of general cognitive performance, EDSS, disease duration and depression. Fatigue correlated with social cognition performance, which might be due to common underlying neuronal networks. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. Impaired social cognition in anorexia nervosa patients

    PubMed Central

    Hamatani, Sayo; Tomotake, Masahito; Takeda, Tomoya; Kameoka, Naomi; Kawabata, Masashi; Kubo, Hiroko; Tada, Yukio; Tomioka, Yukiko; Watanabe, Shinya; Ohmori, Tetsuro

    2016-01-01

    Background The purpose of this study was to investigate the characteristics of social cognition in patients with anorexia nervosa (AN). Methods Eighteen female patients with AN (mean age =35.4±8.6 years) and 18 female healthy controls (HC) (mean age =32.8±9.4 years) participated in the study. Their social cognition was assessed with the Social Cognition Screening Questionnaire (SCSQ). Results The results showed that total score of the SCSQ and scores of theory of mind and metacognition were significantly lower in AN group than those in HC group. Moreover, significant differences in theory of mind, metacognition, and total score of the SCSQ remained when the effects of depression, anxiety, and starvation were eliminated statistically. Conclusion These results suggest that patients with AN may have difficulty inferring other people’s intention and also monitoring and evaluating their own cognitive activities. Therefore, these features may explain some aspects of the pathology of AN. PMID:27785029

  14. Cognitive Impairment Precedes and Predicts Functional Impairment in Mild Alzheimer’s Disease

    PubMed Central

    Liu-Seifert, Hong; Siemers, Eric; Price, Karen; Han, Baoguang; Selzler, Katherine J.; Henley, David; Sundell, Karen; Aisen, Paul; Cummings, Jeffrey; Raskin, Joel; Mohs, Richard

    2015-01-01

    Abstract Background: The temporal relationship of cognitive deficit and functional impairment in Alzheimer’s disease (AD) is not well characterized. Recent analyses suggest cognitive decline predicts subsequent functional decline throughout AD progression. Objective: To better understand the relationship between cognitive and functional decline in mild AD using autoregressive cross-lagged (ARCL) panel analyses in several clinical trials. Methods: Data included placebo patients with mild AD pooled from two multicenter, double-blind, Phase 3 solanezumab (EXPEDITION/2) or semagacestat (IDENTITY/2) studies, and from AD patients participating in the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Cognitive and functional outcomes were assessed using AD Assessment Scale-Cognitive subscale (ADAS-Cog), AD Cooperative Study-Activities of Daily Living instrumental subscale (ADCS-iADL), or Functional Activities Questionnaire (FAQ), respectively. ARCL panel analyses evaluated relationships between cognitive and functional impairment over time. Results: In EXPEDITION, ARCL panel analyses demonstrated cognitive scores significantly predicted future functional impairment at 5 of 6 time points, while functional scores predicted subsequent cognitive scores in only 1 of 6 time points. Data from IDENTITY and ADNI programs yielded consistent results whereby cognition predicted subsequent function, but not vice-versa. Conclusions: Analyses from three databases indicated cognitive decline precedes and predicts subsequent functional decline in mild AD dementia, consistent with previously proposed hypotheses, and corroborate recent publications using similar methodologies. Cognitive impairment may be used as a predictor of future functional impairment in mild AD dementia and can be considered a critical target for prevention strategies to limit future functional decline in the dementia process. PMID:26402769

  15. Cognitive Impairment in Rural Elderly Population in Ecuador

    PubMed Central

    Wong-Achi, Xavier; Egas, Gabriela; Cabrera, Dayana

    2017-01-01

    Introduction: The Mini-Cog is a simple and short test that identifies cognitive impairment. Its detection helps provide an early dementia diagnosis, rapid access to treatments, and even delay or reversion. Materials and Methods: This multicenter, observational, descriptive, and cross-sectional study included 214 patients. Patients enrolled in this study were community dwellers aged ≥55-year-old, without prior diagnosis of cognitive impairment or dementia, with adequate hearing and vision functions. It was conducted in primary care health centers localized in rural communities of Ecuador. Results: Ages ranged from 50 to 98 years and there was predominance of female gender: 66% versus 33%. The percentage of illiteracy was 26.4% (CI: 25.32–27.48), and 63% (CI: 62.1–63.94) of patients had complete primary educational level. The overall prevalence of cognitive impairment was 50.9% (95% CI: 48.5–53.3) and 47.2% (95% CI: 45.2–49.2) in patients with risk factors. We found several established risk factors associated with cognitive impairment onset, including social factors, physiological factors, and comorbidities. Conclusion: This is the first epidemiological research of CI in rural populations in this country using the Mini-Cog as a screening tool. Adopting public health measures for the prevention and control of those modifiable risk factors could reduce the prevalence of cognitive impairment and even its progression to dementia. PMID:28936066

  16. Cognitive Impairment in Rural Elderly Population in Ecuador.

    PubMed

    Wong-Achi, Xavier; Egas, Gabriela; Cabrera, Dayana

    2017-08-01

    The Mini-Cog is a simple and short test that identifies cognitive impairment. Its detection helps provide an early dementia diagnosis, rapid access to treatments, and even delay or reversion. This multicenter, observational, descriptive, and cross-sectional study included 214 patients. Patients enrolled in this study were community dwellers aged ≥55-year-old, without prior diagnosis of cognitive impairment or dementia, with adequate hearing and vision functions. It was conducted in primary care health centers localized in rural communities of Ecuador. Ages ranged from 50 to 98 years and there was predominance of female gender: 66% versus 33%. The percentage of illiteracy was 26.4% (CI: 25.32-27.48), and 63% (CI: 62.1-63.94) of patients had complete primary educational level. The overall prevalence of cognitive impairment was 50.9% (95% CI: 48.5-53.3) and 47.2% (95% CI: 45.2-49.2) in patients with risk factors. We found several established risk factors associated with cognitive impairment onset, including social factors, physiological factors, and comorbidities. This is the first epidemiological research of CI in rural populations in this country using the Mini-Cog as a screening tool. Adopting public health measures for the prevention and control of those modifiable risk factors could reduce the prevalence of cognitive impairment and even its progression to dementia.

  17. Relation between cognitive impairment and early death in the elderly.

    PubMed Central

    Eagles, J M; Beattie, J A; Restall, D B; Rawlinson, F; Hagen, S; Ashcroft, G W

    1990-01-01

    STUDY OBJECTIVE--To study the association between cognitive impairment and early death in elderly patients living in the community. DESIGN--Case-control study of 410 patients assessed by the mental status questionnaire and followed up after three years. SETTING--A general practice in Inverurie, Aberdeenshire, with 14,000 patients. PATIENTS--205 Patients aged greater than or equal to 65 with cognitive impairment according to the mental status questionnaire (score less than or equal to 8) and 205 patients scoring greater than 8 on the questionnaire matched for age and sex. MAIN OUTCOME MEASURE--Death. RESULTS--The relative risk of death in the cognitively impaired patients overall was 3.5. Those patients who scored less than or equal to 7 on the mental status questionnaire were five times more likely to die than their controls. There was no difference in risk of death between those with severe or moderate cognitive impairment. CONCLUSIONS--Cognitive impairment is associated with early death. PMID:2106935

  18. Brain Volumes, Cognitive Impairment, and Conjugated Equine Estrogens

    PubMed Central

    Tindle, Hilary A.; Bushnell, Cheryl A.; Jaramillo, Sarah A.; Kuller, Lewis H.; Margolis, Karen L.; Mysiw, W. Jerry; Maldjian, Joseph A.; Melhem, Elias R.; Resnick, Susan M.

    2009-01-01

    Background Postmenopausal conjugated equine estrogens (CEE) therapies increase the risk of cognitive impairment in women aged 65 years or older and are associated with smaller regional brain volumes; however, the link between these two phenomena has not been established. Methods Standardized magnetic resonance imaging was performed on 1,403 women, 1–4 years after they had participated in randomized placebo-controlled clinical trials of CEE-based therapies. Women included in this report were aged 65–80 years and free of dementia and mild cognitive impairment (MCI) when originally enrolled in the trials, which lasted an average of 4–6 years and were conducted at 14 academic U.S. medical centers. The associations that regional brain volumes and ischemic lesion volumes had with the development of cognitive impairment (i.e., dementia or MCI) were contrasted between treatment groups using analyses of covariance. Results Fifty-three women developed MCI or probable dementia during follow-up. Among women who had been prescribed CEE-based therapies, cognitive impairment was associated with relatively smaller hippocampal (p = .0002) and total brain volumes (p = .03). Qualitatively, these associations appeared to be independent of their level of pretreatment cognitive function. Among women who had been prescribed placebo, these relationships were not evident; instead, cognitive impairment was associated with greater ischemic lesion volume in the frontal lobe (p = .007) and overall (p = .02). Conclusion A mechanism by which CEE-based postmenopausal hormone therapy induces cognitive impairment appears to be through increased brain atrophy. PMID:19729392

  19. Cognitive impairment after intensive care unit admission: a systematic review.

    PubMed

    Wolters, Annemiek E; Slooter, Arjen J C; van der Kooi, Arendina W; van Dijk, Diederik

    2013-03-01

    There is increasing evidence that critical illness and treatment in an intensive care unit (ICU) may result in significant long-term morbidity. The purpose of this systematic review was to summarize the current literature on long-term cognitive impairment in ICU survivors. PubMed/MEDLINE, CINAHL, Cochrane Library, PsycINFO and Embase were searched from January 1980 until July 2012 for relevant articles evaluating cognitive functioning after ICU admission. Publications with an adult population and a follow-up duration of at least 2 months were eligible for inclusion in the review. Studies in cardiac surgery patients or subjects with brain injury or cardiac arrest prior to ICU admission were excluded. The main outcome measure was cognitive functioning. The search strategy identified 1,128 unique studies, of which 19 met the selection criteria and were included. Only one article compared neuropsychological test performance before and after ICU admission. The 19 studies that were selected reported a wide range of cognitive impairment in 4-62 % of the patients after a follow-up of 2-156 months. The results of most studies of the studies reviewed suggest that critical illness and ICU treatment are associated with long-term cognitive impairment. Due to the complexity of defining cognitive impairment, it is difficult to standardize definitions and to reach consensus on how to categorize neurocognitive dysfunction. Therefore, the magnitude of the problem is uncertain.

  20. Depression and cognitive impairment following recovery from thrombotic thrombocytopenic purpura.

    PubMed

    Han, Bowie; Page, Evaren E; Stewart, Lauren M; Deford, Cassandra C; Scott, James G; Schwartz, Lauren H; Perdue, Jedidiah J; Terrell, Deirdra R; Vesely, Sara K; George, James N

    2015-08-01

    After recovery from an acute episode of acquired thrombotic thrombocytopenic purpura (TTP), patients often describe problems with memory, concentration, and endurance. We have previously reported the occurrence of depression and cognitive impairment in these patients. In this study, we describe the frequency, severity, and clinical course of depression and cognitive impairment. Fifty-two (85%) out of 61 eligible Oklahoma Registry patients who had recovered from TTP, documented by ADAMTS13 activity <10%, have had at least one (median, four) evaluation for depression over 11 years using the Beck Depression Inventory-II; 31 (59%) patients screened positive for depression at least once; in 15 (29%), the results suggested severe depression at least once. Nine of these 15 patients had a psychiatric interview, the definitive diagnostic evaluation; the diagnosis of major depressive disorder was established in eight (89%) patients. In 2014, cognitive ability was evaluated in 33 patients by the Montreal Cognitive Assessment and the Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Both tests detected significant cognitive impairment in the patients as a group. Fifteen out of the 33 patients had been evaluated by extensive cognitive tests in 2006. The 2014 RBANS results were significantly worse than the 2006 results for the overall score and two out of the five RBANS domains (immediate and delayed memory). Neither depression nor cognitive impairment was significantly associated with the occurrence of relapses or ADAMTS13 activity <10% during remission. These observations emphasize the importance of screening evaluations for depression and cognitive impairment after recovery from acquired TTP. © 2015 Wiley Periodicals, Inc.

  1. Impaired cognition and attention in adults: pharmacological management strategies

    PubMed Central

    Allain, Hervé; Akwa, Yvette; Lacomblez, Lucette; Lieury, Alain; Bentué-Ferrer, Danièle

    2007-01-01

    Cognitive psychology has provided clinicians with specific tools for analyzing the processes of cognition (memory, language) and executive functions (attention-concentration, abstract reasoning, planning). Neuropsychology, coupled with the neurosciences (including neuroimaging techniques), has authenticated the existence of early disorders affecting the “superior or intellectual” functions of the human brain. The prevalence of cognitive and attention disorders is high in adults because all the diseases implicating the central nervous system are associated with cognitive correlates of variable intensity depending on the disease process and the age of the patient. In some pathologies, cognitive impairment can be a leading symptom such as in schizophrenia, posttraumatic stress disorder or an emblematic stigmata as in dementia including Alzheimer’s disease. Paradoxically, public health authorities have only recognized as medications for improving cognitive symptoms those with proven efficacy in the symptomatic treatment of patients with Alzheimer’s disease; the other cognitive impairments are relegated to the orphanage of syndromes and symptoms dispossessed of medication. The purpose of this review is to promote a true “pharmacology of cognition” based on the recent knowledge in neurosciences. Data from adult human beings, mainly concerning memory, language, and attention processes, will be reported. “Drug therapeutic strategies” for improving cognition (except for memory function) are currently rather scarce, but promising perspectives for a new neurobiological approach to cognitive pharmacology will be highlighted. PMID:19300541

  2. Finances in the Older Patient with Cognitive Impairment

    PubMed Central

    Widera, Eric; Steenpass, Veronika; Marson, Daniel; Sudore, Rebecca

    2013-01-01

    Financial capacity is the ability to manage money and financial assets in ways that meet a person’s needs and which are consistent with his/her values and self-interest. Financial capacity is essential for an individual to function independently in our society; however, dementia eventually leads to a complete loss of financial capacity. Many patients with cognitive impairment and their families turn to their primary care clinician for help with financial impairment, yet most clinicians do not understand their role or how to help. We review the prevalence and impact of financial incapacity in older adults with cognitive impairment. We also articulate the role of the primary clinician which includes: (1) educating older adult patients and families about the need for advance financial planning; (2) recognizing signs of possible impaired financial capacity; (3) assessing financial impairments in cognitively impaired adults; (4) recommending interventions to help patients maintain financial independence; and (5) knowing when and to whom to make medical and legal referrals. Clearly delineating the clinician’s role in financial impairment can lead to the establishment of effective financial protections and can limit the economic, psychological, and legal hardships of financial incapacity on patients with dementia and their families. PMID:21325186

  3. Type 1 Diabetes Mellitus and Cognitive Impairments: A Systematic Review.

    PubMed

    Li, Wei; Huang, Edgar; Gao, Sujuan

    2017-01-01

    Type 1 diabetes mellitus (T1DM) is a major subtype of diabetes and is usually diagnosed at a young age with insulin deficiency. The life expectancy of T1DM patients has increased substantially in comparison with that three decades ago due to the availability of exogenous insulin, though it is still shorter than that of healthy people. However, the relation remains unclear between T1DM and dementia as an aging-related disease. We conducted a systematic review of existing literature on T1DM and cognition impairments by carrying out searches in electronic databases Medline, EMBASE, and Google Scholar. We restricted our review to studies involving only human subjects and excluded studies on type 2 diabetes mellitus or non-classified diabetes. A meta-analysis was first performed on the relationship between T1DM and cognitive changes in youths and adults respectively. Then the review focused on the cognitive complications of T1DM and their relation with the characteristics of T1DM, glycemic control, diabetic complications, comorbidities, and others. First, age at onset, disease duration, and glycemic dysregulation were delineated for their association with cognitive changes. Then diabetic ketoacidosis, angiopathy, and neuropathy were examined as diabetic complications for their involvement in cognitive impairments. Lastly, body mass index and blood pressure were discussed for their relations with the cognitive changes. Future studies are needed to elucidate the pathogenesis of T1DM-related cognitive impairments or dementia.

  4. Identifying a cognitive impairment subgroup in adults with mood disorders

    PubMed Central

    Iverson, Grant L.; Brooks, Brian L.; Langenecker, Scott A.; Young, Allan H.

    2014-01-01

    Background We hypothesized that only a minority of patients with mood disorders have measurable cognitive impairment, and this minority drives the small-to-medium effect sizes detected in group studies. Removal of this minority from group statistical analyses will illustrate that the majority appear to have broadly normal cognitive functioning. Methods Participants were adults between the ages of 20 and 54, including 659 healthy control subjects, 84 unmedicated outpatients diagnosed with depression, 59 outpatients diagnosed with depression who were on medications at the time of the evaluation, and 43 outpatients with bipolar disorder. All completed the CNS Vital Signs computerized cognitive screening battery. Results The prevalence rates of low cognitive test scores were calculated for the healthy control subjects and the patients with mood disorders. Having two scores at or below the 5th percentile occurred in 31.2% of the patients and only 8.2% of the control subjects [χ2(1)=66.67, p<.0001; Odds Ratio=5.1, 95% CI=3.4–7.7]. For the control subjects, this low false positive rate for cognitive impairment was maintained across age groups, sexes, and education levels. A larger proportion of patients with bipolar disorder (41.9%) than patients with depression (27.1–28.6%) met this criterion for cognitive impairment. Conclusions This study suggests that cognitive impairment associated with mood disorders is limited to a minority of patients with the majority being broadly cognitively normal. Future research should determine if this identified subgroup has neuroanatomical, neurophysiological, or neuroendocrine abnormalities. Cognitive screening tools of this type might be useful in selecting participants for studies. PMID:21439647

  5. Perceived Cognitive Impairment among African American elders: health and functional impairments in daily life

    PubMed Central

    Ficker, Lisa J.; Lysack, Cathy L.; Hanna, Mena; Lichtenberg, Peter A.

    2014-01-01

    Objectives The Center for Disease Control began to assess Perceived Cognitive Impairment in 2009, yet there has been no in-depth study of how perceived decline in thinking or memory skills may be associated to the health and lifestyle of an independent community-dwelling older person. Among urban-dwelling older African Americans who are at elevated risk for cognitive impairment and dementia, we know even less regarding the interaction of these risk factors. Method Five hundred and one African American elders (n = 501) between the ages of 55 and 95 with an average age of 70.73 years (SD = 8.6 years) participated in telephone interviews. Results Approximately one-third of the elders reported that their memory, thinking skills, or ability to reason was worse than a year ago (n = 150; 29.9%) and 25% of this group (n = 38) reported that this Perceived Cognitive Impairment impacted their daily activities and/or warranted a consultation with their doctor. Bivariate analyses indicated that Perceived Cognitive Impairment was associated with increased health problems, mobility limitations, depressed mood, and lower social functioning. Conclusion Elders who reported that cognitive problems impacted their daily functioning reported the greatest health and mental health problems. Perceived Cognitive Impairment is an important health variable with implications for an older adult’s overall health, mobility, and mental health. PMID:24328435

  6. Atherosclerotic risk factors, vascular cognitive impairment, and Alzheimer disease.

    PubMed

    Kovacic, Jason C; Fuster, Valentin

    2012-01-01

    The involvement of vascular factors in Alzheimer dementia was first appreciated over 100 years ago. Recently, significant advances in our understanding of these brain-vascular relationships have taken place. Vascular cognitive impairment is now recognized as a distinct group of interrelated vascular-based neurological insults that can accumulate and lead to dementia. Importantly, the pathology of vascular cognitive impairment extends far beyond brain destruction wrought by major stroke. Other subtle changes may also arise that contribute to vascular cognitive impairment and dementia, including subclinical stroke, white-matter changes such as hyperintensities and lipohyalinosis, small lacunar infarcts, cerebral hypoperfusion, and compromise of the blood-brain barrier. In this review we critically examine the emerging body of evidence that relates atherosclerotic risk factors, brain functioning, and Alzheimer disease. © 2012 Mount Sinai School of Medicine.

  7. Chemotherapy-related cognitive impairment in older patients with cancer

    PubMed Central

    Loh, Kah Poh; Janelsins, Michelle C.; Mohile, Supriya G.; Holmes, Holly M.; Hsu, Tina; Inouye, Sharon K.; Karuturi, Meghan S.; Kimmick, Gretchen G.; Lichtman, Stuart M.; Magnuson, Allison; Whitehead, Mary I.; Wong, Melisa L.; Ahles, Tim A.

    2016-01-01

    Chemotherapy-related cognitive impairment (CRCI) can occur during or after chemotherapy and represents a concern for many patients with cancer. Among older patients with cancer, in whom there is little clinical trial evidence examining side effects like CRCI, many unanswered questions remain regarding risk for and resulting adverse outcomes from CRCI. Given the rising incidence of cancer with age, CRCI is of particular concern for older patients with cancer who receive treatment. Therefore, research related to CRCI in older patients with cancers is a high priority. In this manuscript, we discuss current gaps in research highlighting the lack of clinical studies of CRCI in older adults, the complex mechanisms of CRCI, and the challenges in measuring cognitive impairment in older patients with cancer. Although we focus on CRCI, we also discuss cognitive impairment related to cancer itself and other treatment modalities. We highlight several research priorities to improve the study of CRCI in older patients with cancer. PMID:27197918

  8. Cognitive impairments in Hashimoto's encephalopathy: a case-control study.

    PubMed

    Wang, Jianhong; Zhang, Jun; Xu, Lan; Shi, Yunbo; Wu, Xunyi; Guo, Qihao

    2013-01-01

    Hashimoto's encephalopathy is considered as a treatable dementia, but it is often misdiagnosed. We investigated cognitive impairment and the MRI pathology of Hashimoto's encephalopathy patients. The study comprised eight patients with Hashimoto's encephalopathy, 16 patients with mild Alzheimer's disease and 24 healthy subjects. A neuropsychological battery included assessments of memory, language, attention, executive function and visuospatial ability. Cranial MRI was obtained from all Hashimoto's encephalopathy patients. Hashimoto's encephalopathy and mild Alzheimer's disease showed cognitive impairments in episodic memory, attention, executive function and visuospatial ability, but naming ability was unaffected in Hashimoto's encephalopathy. The MRI of Hashimoto's encephalopathy showed leukoencephalopathy-like type or limbic encephalitis-like type; the lesions did not affect the temporal cortex which plays a role in naming ability. Except that the naming ability was retained, the impairments in cognitive functions for the Hashimoto's encephalopathy patients were similar to those of Alzheimer's disease patients. These results were consistent with the MRI findings.

  9. Depressive symptoms predict incident cognitive impairment in cognitive healthy older women

    PubMed Central

    Rosenberg, Paul B.; Mielke, Michelle M.; Xue, Qian-Li; Carlson, Michelle C.

    2009-01-01

    OBJECTIVES There is increasing evidence that depressive symptoms are associated with the development of cognitive impairment and dementia in late life. We sought to examine whether depression increased the risk of incident cognitive impairment in a longitudinal study of older women. DESIGN observational study, up to 6 examinations spanning up to 9 years. SETTING university-based Division of Geriatric Medicine PARTICIPANTS community-based sample of 436 older, non-demented women MEASUREMENTS Participants were followed with regular medical and neuropsychiatric evaluations. Cognitive assessment included episodic immediate and delayed memory, psychomotor speed, and executive functioning. Participants were characterized as having incident impairment on a cognitive test when scores fell below the tenth percentile on age-adjusted norms. Baseline depressive symptoms were measured using the Geriatric Depression Scale (GDS) (30-item). Discrete-time Cox Proportional hazards regression with generalized linear models were used to determine whether baseline risk factors predicted incident impairment on each cognitive test, defined as performance below the tenth percentile on age-adjusted norms. RESULTS Baseline GDS was highly associated with incident impairment on all cognitive tests (p <.03). These associations were unaffected by vascular conditions except diabetes, which was associated with incident impairment in delayed recall and psychomotor speed. CONCLUSIONS These data suggest that depression may be risk factors for cognitive decline, and thus a potential target for diagnostic and therapeutic interventions. PMID:20224517

  10. Olfactory identification and cognitive performance in community-dwelling older adults with mild cognitive impairment.

    PubMed

    Makizako, Mihoko; Makizako, Hyuma; Doi, Takehiko; Uemura, Kazuki; Tsutsumimoto, Kota; Miyaguchi, Hideki; Shimada, Hiroyuki

    2014-01-01

    Olfactory impairment constitutes one of the earliest signs of Alzheimer's disease in older adults with mild cognitive impairment. We investigated which aspects of neuropsychological measures are correlated with olfactory identification performance among older adults with mild cognitive impairment. Total of 220 participants with mild cognitive impairment (mean age 71.7 years) were examined. Odor identification was assessed using the Open Essence test. Participants underwent comprehensive neurocognitive evaluation, including measures of verbal memory, visual memory, working memory, attention/executive function, and processing speed. We examined associations between olfactory function and cognitive performance scores. Participants with severe hyposmia exhibited significantly poor verbal and visual memory performance, attention/executive function, and slower processing speed scores compared with those without severe hyposmia. In multivariable logistic regression models, better performance scores on verbal and visual memory were significantly associated with decreased likelihood of severe hyposmia after adjusting for age, sex, education, and other cognitive performance scores. These findings suggest that olfactory impairment might be more closely associated with memory loss compared with other aspects of cognitive functioning in mild cognitive impairment subjects.

  11. Cognitive Impairment Associated with Atrial Fibrillation: A Meta-analysis

    PubMed Central

    Kalantarian, Shadi; Stern, Theodore A.; Mansour, Moussa; Ruskin, Jeremy N.

    2015-01-01

    Background Atrial fibrillation (AF) has been linked with an increased risk of cognitive impairment and dementia. Purpose To complete a meta-analysis of studies examining the association between AF and cognitive impairment. Data Sources Electronic search of 5 large databases and hand search of article references. Study Selection Prospective and non-prospective studies reporting adjusted risk estimates for the relationship between AF and cognitive impairment. Data Extraction Two abstracters independently extracted data on study characteristics, risk estimates, methods of AF and outcome ascertainment, and methodological quality. Data Synthesis Twenty one studies were included in the meta-analysis. AF was significantly associated with a higher risk of cognitive impairment independent of stroke history (relative risk (RR) [95% confidence interval (CI)] =1.34 [1.13, 1.58]), in patients with first-ever or recurrent stroke (RR [95%] =2.7 [1.82, 4.00]) and in a broader population including patients with or without a history of stroke (RR [95% CI] =1.4 [1.19, 1.64]). However, there was significant heterogeneity among studies of the broader population (I2 =69.4 %). Limiting the analysis to prospective studies yielded similar results (RR [95% CI] =1.36 [1.12, 1.65]). Restricting the analysis to studies of dementia eliminated the significant heterogeneity (P value =0.137) but did not alter the pooled estimate substantially (RR [95% CI] = 1.38 [1.22, 1.56]). Limitations There is an inherent bias due to confounding variables in observational studies. There was significant heterogeneity among included studies. Conclusions Evidence suggests that AF is associated with a higher risk of cognitive impairment and dementia, with or without a history of clinical stroke. Further studies are required to elucidate the relationship between AF and subtypes of dementia as well as the etiology of cognitive impairment. PMID:23460057

  12. Impact of perceived cognitive impairment in breast cancer survivors.

    PubMed

    Von Ah, Diane; Habermann, Barbara; Carpenter, Janet S; Schneider, Brandy L

    2013-04-01

    Cognitive impairment is commonly reported by breast cancer survivors, yet little is known regarding its impact on quality of life. The purpose of this study was to obtain a better understanding of breast cancer survivors' experiences of perceived cognitive impairment, its trajectory, and its impact on relationships, daily functioning, work and overall life satisfaction after breast cancer diagnosis and treatment. The results are based on qualitative interviews with 22 breast cancer survivors who reported cognitive impairment and who were at least 1 year post-chemotherapy treatment. Interviews were recorded, transcribed verbatim, and analyzed using a content analysis approach. Breast cancer survivors' primarily expressed concerns in 6 major domains including: short-term memory, long-term memory, speed of processing, attention and concentration, language and executive functioning. Concerns emerged as salient after treatment ended as other problems resolved. All of the survivors found these impairments frustrating, and some also reported these changes as detrimental to their self-confidence and social relationships. Employed survivors reported working harder to perform tasks and use of compensatory strategies to complete work tasks. Validation of perceived cognitive impairment by family, friends, and healthcare providers was perceived as important to adjustment. Perceived cognitive deficits have broad implications for the well-being of breast cancer survivors. Study findings underscore the broad consequences of this symptom, provide direction for theory development, measurement selection, and additional intervention targets. A greater understanding of cognitive impairment in breast cancer survivors may lead to the development of effective treatment of this symptom. Published by Elsevier Ltd.

  13. Hypertension Severity Is Associated With Impaired Cognitive Performance.

    PubMed

    Muela, Henrique C S; Costa-Hong, Valeria A; Yassuda, Mônica S; Moraes, Natália C; Memória, Claudia M; Machado, Michel F; Macedo, Thiago A; Shu, Edson B S; Massaro, Ayrton R; Nitrini, Ricardo; Mansur, Alfredo J; Bortolotto, Luiz A

    2017-01-11

    Most evidence of target-organ damage in hypertension (HTN) is related to the kidneys and heart. Cerebrovascular and cognitive impairment are less well studied. Therefore, this study analyzed changes in cognitive function in patients with different stages of hypertension compared to nonhypertensive controls. In a cross-sectional study, 221 (71 normotensive and 150 hypertensive) patients were compared. Patients with hypertension were divided into 2 stages according to blood pressure (BP) levels or medication use (HTN-1: BP, 140-159/90-99 or use of 1 or 2 antihypertensive drugs; HTN-2: BP, ≥160/100 or use of ≥3 drugs). Three groups were comparatively analyzed: normotension, HTN stage 1, and HTN stage 2. The Mini-Mental State Examination, Montreal Cognitive Assessment, and a validated comprehensive battery of neuropsychological tests that assessed 6 main cognitive domains were used to determine cognitive function. Compared to the normotension and HTN stage-1, the severe HTN group had worse cognitive performance based on Mini-Mental State Examination (26.8±2.1 vs 27.4±2.1 vs 28.0±2.0; P=0.004) or Montreal Cognitive Assessment (23.4±3.7 vs 24.9±2.8 vs 25.5±3.2; P<0.001). On the neuropsychological tests, patients with hypertension had worse performance in language, processing speed, visuospatial abilities, and memory. Age, hypertension stage, and educational level were the best predictors of cognitive impairment in patients with hypertension in different cognitive domains. Cognitive impairment was more frequent in patients with hypertension, and this was related to hypertension severity. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  14. Correlates of recognition memory performance in amnestic mild cognitive impairment.

    PubMed

    Sanborn, Victoria; Putcha, Deepti; Tremont, Geoffrey

    2017-05-28

    Determining whether the etiology of amnestic Mild Cognitive Impairment (aMCI) is Alzheimer's disease (AD) is challenging. Recognition memory (RM) performance could be helpful in identifying individuals with cognitive patterns indicative of underlying AD. In order to better identify such patterns, we examined RM discriminability in aMCI and its associations with nonmemory cognitive domains impaired in AD. Participants were 97 individuals diagnosed with aMCI (Mage = 74.48 years) who underwent comprehensive neuropsychological evaluation. Zero-order correlations and hierarchical linear regression analyses were conducted to determine associations between discriminability on the HVLT-R and specific tasks within the domains of executive function (EF) and language, controlling for age and education. Logistic regression was conducted to determine whether performance on individual tasks was predictive of group membership defined as impaired or unimpaired on RM performance. While 100% of the aMCI group showed impaired delayed recall on a word list, we found that 69% were impaired on RM discriminability, while 31% were not. Discriminability impairment groups did not differ on demographics or global cognition. For the entire aMCI group, performance in the language domain and, specifically, on a confrontation naming task significantly predicted RM discriminability. Confrontation naming was predictive of RM impairment group membership. Our results demonstrate individuals with aMCI are heterogeneous and show variability in RM discriminability. RM performance was associated with measures of language, elucidating patterns of cognition potentially marking those more likely to progress to AD. Future studies need to address this finding in a longitudinal sample.

  15. Acetaminophen attenuates lipopolysaccharide-induced cognitive impairment through antioxidant activity.

    PubMed

    Zhao, Wei-Xing; Zhang, Jun-Han; Cao, Jiang-Bei; Wang, Wei; Wang, Dong-Xin; Zhang, Xiao-Ying; Yu, Jun; Zhang, Yong-Yi; Zhang, You-Zhi; Mi, Wei-Dong

    2017-01-21

    Considerable evidence has shown that neuroinflammation and oxidative stress play an important role in the pathophysiology of postoperative cognitive dysfunction (POCD) and other progressive neurodegenerative disorders. Increasing evidence suggests that acetaminophen (APAP) has unappreciated antioxidant and anti-inflammatory properties. However, the impact of APAP on the cognitive sequelae of inflammatory and oxidative stress is unknown. The objective of this study is to explore whether APAP could have neuroprotective effects on lipopolysaccharide (LPS)-induced cognitive impairment in mice. A mouse model of LPS-induced cognitive impairment was established to evaluate the neuroprotective effects of APAP against LPS-induced cognitive impairment. Adult C57BL/6 mice were treated with APAP half an hour prior to intracerebroventricular microinjection of LPS and every day thereafter, until the end of the study period. The Morris water maze was used to assess cognitive function from postinjection days 1 to 3. Animal behavioural tests as well as pathological and biochemical assays were performed to evaluate LPS-induced hippocampal damage and the neuroprotective effect of APAP. Mice treated with LPS exhibited impaired performance in the Morris water maze without changing spontaneous locomotor activity, which was ameliorated by treatment with APAP. APAP suppressed the accumulation of pro-inflammatory cytokines and microglial activation induced by LPS in the hippocampus. In addition, APAP increased SOD activity, reduced MDA levels, modulated glycogen synthase kinase 3β (GSK3β) activity and elevated brain-derived neurotrophic factor (BDNF) expression in the hippocampus. Moreover, APAP significantly decreased the Bax/Bcl-2 ratio and neuron apoptosis in the hippocampus of LPS-treated mice. Our results suggest that APAP may possess a neuroprotective effect against LPS-induced cognitive impairment and inflammatory and oxidative stress via mechanisms involving its antioxidant and

  16. Benign multiple sclerosis: physical and cognitive impairment follow distinct evolutions.

    PubMed

    Gajofatto, A; Turatti, M; Bianchi, M R; Forlivesi, S; Gobbin, F; Azzarà, A; Monaco, S; Benedetti, M D

    2016-03-01

    Benign multiple sclerosis (BMS) definitions rely on physical disability level but do not account sufficiently for cognitive impairment which, however, is not rare. To study the evolution of physical disability and cognitive performance of a group of patients with BMS followed at an University Hospital Multiple Sclerosis Center. A consecutive sample of 24 BMS cases (diagnosis according to 2005 McDonald's criteria, relapsing-remitting course, disease duration ≥ 10 years, and expanded disability status scale [EDSS] score ≤ 2.0) and 13 sex- and age-matched non-BMS patients differing from BMS cases for having EDSS score 2.5-5.5 were included. Main outcome measures were as follows: (i) baseline and 5-year follow-up cognitive impairment defined as failure of at least two tests of the administered neuropsychological battery; (ii) EDSS score worsening defined as confirmed increase ≥ 1 point (or 0.5 point if baseline EDSS score = 5.5). At inclusion, BMS subjects were 41 ± 8 years old and had median EDSS score 1.5 (range 0-2), while non-BMS patients were 46 ± 8 years old and had median EDSS score 3.0 (2.5-5.5). At baseline 16% of patients in both groups were cognitively impaired. After 5 years, EDSS score worsened in 8% of BMS and 46% of non-BMS patients (P = 0.008), while the proportion of cognitively impaired subjects increased to 25% in both groups. Patients with BMS had better physical disability outcome at 5 years compared to non-BMS cases. However, cognitive impairment frequency and decline over time appeared similar. Neuropsychological assessment is essential in patients with BMS given the distinct pathways followed by disease progression in cognitive and physical domains. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Polypharmacy Cut-Off for Gait and Cognitive Impairments

    PubMed Central

    Pothier, Kristell; Morello, Remy; Lelong-Boulouard, Véronique; Lescure, Pascale; Bocca, Marie-Laure; Marcelli, Christian; Descatoire, Pablo; Chavoix, Chantal

    2016-01-01

    Background: Polypharmacy is a well-established risk factor for falls, and these are one of the major health problems that affect the quality of life as people age. However, the risk of mobility and cognitive impairments consecutive to polypharmacy has been little addressed, despite the association between these adverse outcomes and falls. Moreover, the rare polypharmacy cut-offs were all but one arbitrarily determined. Objective: Studying relationships between polypharmacy and both mobility and cognitive impairments, and statistically determining a cut-off point in the number of medicinal molecule beyond which polypharmacy has deleterious consequences with respect to mobility and cognitive impairment. Methods: We enrolled 113 community-dwelling adults aged 55 years and older with a fall history, with or without injury, in the previous year. We carefully collected information about daily medicinal molecules taken. We assessed basic mobility and global cognition with the Time-Up-and-Go and the Montreal Cognitive Assessment (MoCA) test, respectively (clinicaltrials.gov NCT02292316). Results: Timed-Up and Go test and MoCA scores were both significantly correlated with the number of molecule, used. Receiver Operating Characteristic curves indicate, with high prediction (p < 0.002), that daily consumption of five or more molecules is associated with risk for both impaired mobility and global cognition. These relationships were independent of the number of comorbidities and of the pharmacological class. Conclusion: Community-dwelling adults aged 55 years and older who take five or more daily medicinal molecules are at high risk for both mobility and cognitive impairments. Physicians and patients should be aware of these new findings, especially when there are multiple prescribers involved in the care of the patient. PMID:27630572

  18. Mild Cognitive Impairment: Diagnosis, Longitudinal Course, and Emerging Treatments

    PubMed Central

    Vega, Jennifer N.; Newhouse, Paul A.

    2014-01-01

    Mild cognitive impairment (MCI) is widely regarded as the intermediate stage of cognitive impairment between the changes seen in normal cognitive aging and those associated with dementia. Elderly patients with MCI constitute a high-risk population for developing dementia, in particular Alzheimer’s disease (AD). Although the core clinical criteria for MCI have remained largely unchanged, the operational definition of MCI has undergone several revisions over the course of the last decade and remains an evolving diagnosis. Prognostic implications of this diagnosis are becoming clearer with regard to the risk of progressive cognitive deterioration. Although patients with MCI may represent an optimal target population for pharmacological and non-pharmacological interventions, results from clinical trials have been mixed and a definitive effective treatment remains elusive. This article provides a brief overview of the evolution of the concept of MCI and reviews current diagnostic criteria, the longitudinal course of the disorder, and current and emerging treatments for MCI. PMID:25160795

  19. Cognitive Impairment and Dementia in Patients with Parkinson Disease

    PubMed Central

    Leverenz, James B.; Quinn, Joseph F.; Zabetian, Cyrus; Zhang, Jing; Montine, Kathleen S.; Montine, Thomas J.

    2009-01-01

    Parkinson disease (PD) is an already prevalent neurodegenerative disease that is poised to at least double over the next 25 years. Although best known for its characteristic movement disorder, PD is now appreciated commonly to cause cognitive impairment, including dementia, and behavioral changes. Dementia in patients with PD is consequential and has been associated with reduced quality of life, shortened survival, and increased caregiver distress. Here we review clinical presentation and progression, pathological bases, identification of genetic risk factors, development of small molecule biomarkers, and emerging treatments for cognitive impairment in patients with PD. PMID:19754405

  20. [Dementia and mild cognitive impairment in Parkinson's disease: a review].

    PubMed

    Bocanegra, Yamile; Trujillo-Orrego, Natalia; Pineda, David

    2014-12-16

    INTRODUCTION. The cognitive disorders in Parkinson's disease (PD) have traditionally been associated with the presence of dementia in later stages of the disease. Recent studies, however, consider that cognitive impairment can appear as of early stages. Knowing the cognitive profile of PD furthers our understanding of the clinical phenotype, making it easier to reach a timely diagnosis and favouring intervention on the symptoms from the initial stages. AIM. To present a review of the literature on mild cognitive impairment (MCI) and dementia associated with PD. DEVELOPMENT. Several studies report that patients with PD who have a prolonged time to progression develop dementia. Yet, there have also been reports claiming that, as of the early stages, patients can present subtle cognitive alterations known as MCI. The initial neuropsychological profile is mainly of a non-amnesic type, characterised by executive dysfunction, alterations affecting attention, operative memory deficit and faulty retrieval of information. When patients develop dementia, disorders will arise in the storage of information, in semantic fluency, and in visuospatial and visuoperceptual skills. Currently there are criteria available for diagnosing the MCI and dementia associated with PD, as well as valid reliable instruments for detecting those disorders. CONCLUSIONS. Cognitive symptoms are frequent in PD. From the initial stages of the disease onwards patients may present MCI that is mainly characterised by a fronto-subcortical cognitive profile, whereas dementia usually develops at later stages, when a pattern of posterior cortical cognitive disorder is also observed.

  1. Inflammation and white matter damage in vascular cognitive impairment.

    PubMed

    Rosenberg, Gary A

    2009-03-01

    Vascular cognitive impairment is a term used to describe a heterogeneous group of diseases, including large vessel disease with strategic single and multiple strokes and small vessel disease with progressive damage to the deep white matter. Identification of patients with the progressive form of vascular cognitive impairment, referred to by some investigators as Binswanger disease, is important for treatment trials. Pathologically, Binswanger disease is associated with small vessel disease, extensive regions of demyelination, inflammatory cells around damaged blood vessels, and lacunar infarcts. Clinically, patients with Binswanger disease have impairments of gait and balance, focal neurological findings, and executive dysfunction on neuropsychological tests. White matter changes on MRI are thought to be due to hypoxic episodes related to hypoperfusion of the vulnerable deep white matter secondary to hypertension, diabetes, and other vessel diseases. Disruption of the blood-brain barrier suggests an inflammatory response. Matrix metalloproteinases are present in the brain of patients with vascular cognitive impairment and can be measured in the cerebrospinal fluid of some patients. Preliminary studies with quantification of the blood-brain barrier, using the multiple time graphical method (Patlak plots), supports disruption of the blood-brain barrier. Because no single clinical feature or diagnostic test is sufficient to identify patients with the small vessel form of vascular cognitive impairment, we propose that a multimodal approach will be needed to select patients for treatment trials.

  2. Inflammation and White Matter Damage in Vascular Cognitive Impairment

    PubMed Central

    Rosenberg, Gary A.

    2009-01-01

    Vascular cognitive impairment is a term used to describe a heterogeneous group of diseases, including large vessel disease with strategic single and multiple strokes and small vessel disease with progressive damage to the deep white matter. Identification of patients with the progressive form of vascular cognitive impairment, referred to by some investigators as Binswanger disease, is important for treatment trials. Pathologically, Binswanger disease is associated with small vessel disease, extensive regions of demyelination, inflammatory cells around damaged blood vessels, and lacunar infarcts. Clinically, patients with Binswanger disease have impairments of gait and balance, focal neurological findings, and executive dysfunction on neuropsychological tests. White matter changes on MRI are thought to be due to hypoxic episodes related to hypoperfusion of the vulnerable deep white matter secondary to hypertension, diabetes, and other vessel diseases. Disruption of the blood– brain barrier suggests an inflammatory response. Matrix metalloproteinases are present in the brain of patients with vascular cognitive impairment and can be measured in the cerebrospinal fluid of some patients. Preliminary studies with quantification of the blood–brain barrier, using the multiple time graphical method (Patlak plots), supports disruption of the blood–brain barrier. Because no single clinical feature or diagnostic test is sufficient to identify patients with the small vessel form of vascular cognitive impairment, we propose that a multimodal approach will be needed to select patients for treatment trials. PMID:19064797

  3. Radiation-induced cognitive impairment-from bench to bedside

    PubMed Central

    Greene-Schloesser, Dana; Robbins, Mike E.

    2012-01-01

    Approximately 100 000 patients per year in the United States with primary and metastatic brain tumor survive long enough (>6 months) to develop radiation-induced brain injury. Before 1970, the human brain was thought to be radioresistant; the acute central nervous system (CNS) syndrome occurs after single doses of ≥30 Gy, and white matter necrosis can occur at fractionated doses of ≥60 Gy. Although white matter necrosis is uncommon with modern radiation therapy techniques, functional deficits, including progressive impairments in memory, attention, and executive function have become increasingly important, having profound effects on quality of life. Preclinical studies have provided valuable insights into the pathogenic mechanisms involved in radiation-induced cognitive impairment. Although reductions in hippocampal neurogenesis and hippocampal-dependent cognitive function have been observed in rodent models, it is important to recognize that other brain regions are affected; non–hippocampal-dependent reductions in cognitive function occur. Neuroinflammation is viewed as playing a major role in radiation-induced cognitive impairment. During the past 5 years, several preclinical studies have demonstrated that interventional therapies aimed at modulating neuroinflammation can prevent/ameliorate radiation-induced cognitive impairment independent of changes in neurogenesis. Translating these exciting preclinical findings to the clinic offers the promise of improving the quality of life in patients with brain tumors who receive radiation therapy. PMID:23095829

  4. Does PTSD impair cognition beyond the effect of trauma?

    PubMed

    Qureshi, Salah U; Long, Mary E; Bradshaw, Major R; Pyne, Jeffrey M; Magruder, Kathy M; Kimbrell, Timothy; Hudson, Teresa J; Jawaid, Ali; Schulz, Paul E; Kunik, Mark E

    2011-01-01

    This systematic review analyzed data from studies examining memory and cognitive function in subjects with posttraumatic stress disorder (PTSD), compared with subjects exposed to trauma (but without PTSD). Based on analysis of 21 articles published in English from 1968 to 2009, the conclusion is that individuals with PTSD, particularly veterans, show signs of cognitive impairment when tested with neuropsychological instruments, more so than individuals exposed to trauma who do not have PTSD.

  5. [Forgetfulness and light cognitive impairment. What can the physician still tolerate?].

    PubMed

    Förstl, H; Bickel, H; Lautenschlager, N; Riemenschneider, M; Kurz, A

    2001-06-07

    Forgetfulness is defined as a subjectively bothersome impairment of the ability to recall facts that are unequivocally known to be stored in the memory. Objectifiable memory deficits may accompany numerous physical and neurological illnesses, but may also be seen in depressive states. Below average-for-age cognitive performances that do not reach the level of dementia are referred to as mild cognitive impairment, which in some cases represents a pre-dementia stage of Alzheimer's disease. Its recognition and differentiation from age-related performance deficits is now possible using simple, but sensitive neuropsychological tests. An important aim of the diagnostic work-up is the recognition of potentially reversible causes. For this purpose, physical examination and laboratory investigations are helpful. Structural and functional imaging procedures can provide information about cerebral causes. Biochemical indicators of neurogenerative processes are currently being developed. Cognitive training measures possibly have only a small and temporary effect. In patients with mild cognitive impairment, nootropic agents apparently have a symptomatic effect. Whether antidementia agents are capable of stopping the progress of mild cognitive impairment to full-blown dementia is currently being investigated in ongoing trials.

  6. Gluten-induced cognitive impairment ("brain fog") in coeliac disease.

    PubMed

    Yelland, Gregory W

    2017-03-01

    Much is known about the serious neurological effects of gluten ingestion in coeliac disease patients, such as sporadic ataxia and peripheral neuropathy, although the causal links to gluten are still under debate. However, such disorders are observed in only a small percentage of coeliac patients. Much less is known about the transient cognitive impairments to memory, attention, executive function, and the speed of cognitive processing reported by the majority of patients with coeliac disease. These mild degradations of cognitive functions, referred to as "brain fog," are yet to be formally recognized as a medical or psychological condition. However, subtle tests of cognitive function are measurable in untreated patients with coeliac disease and improve over the first 12 months' therapy with a gluten-free diet. Such deficits also occur in patients with Crohn's disease, particularly in association with systemic inflammatory activity. Thus, cognitive impairments associated with brain fog are psychologically and neurologically real and improve with adherence to a gluten-free diet. There is not yet sufficient evidence to provide a definitive account of the mechanism by which gluten ingestion causes the impairments to cognitive function associated with brain fog, but current evidence suggests that it is more likely that the causal factor is not directly related to exposure to gluten.

  7. Cognitive impairment in preclinical Alzheimer's disease: a meta-analysis.

    PubMed

    Bäckman, Lars; Jones, Sari; Berger, Anna-Karin; Laukka, Erika Jonsson; Small, Brent J

    2005-07-01

    To determine the size of the impairment across different cognitive domains in preclinical Alzheimer's disease (AD), a meta-analysis based on 47 studies involving 9,097 controls and 1,207 preclinical AD cases was conducted. There were marked preclinical deficits in global cognitive ability, episodic memory, perceptual speed, and executive functioning; somewhat smaller deficits in verbal ability, visuospatial skill, and attention; and no preclinical impairment in primary memory. Younger age (< 75 years) and shorter follow-up intervals (< 3 years) were associated with larger effect sizes for both global cognitive ability and episodic memory. For global cognitive ability, studies that used population-based sampling yielded larger effect sizes; for episodic memory, larger differences were seen in studies that preidentified groups in terms of baseline cognitive impairment. Within episodic memory, delayed testing and recall-based assessment resulted in the largest effect sizes. The authors conclude that deficits in multiple cognitive domains are characteristic of AD several years before clinical diagnosis. The generalized nature of the deficit is consistent with recent observations that multiple brain structures and functions are affected long before the AD diagnosis. ((c) 2005 APA, all rights reserved).

  8. Mild Cognitive Impairment in Parkinson’s Disease

    PubMed Central

    Goldman, JG.; Litvan, I.

    2012-01-01

    While Parkinson’s disease (PD) traditionally has been defined by its characteristic motor hallmarks, non-motor features such as cognitive impairment and dementia are increasingly recognized as part of PD. Mild cognitive impairment is common in non-demented PD patients, occurring in about 20-50%. Frequency estimates and clinical features of mild cognitive impairment in PD (PD-MCI), however, vary across studies due to methodological differences and lack of uniform diagnostic criteria for PD-MCI. Overall, PD-MCI patients exhibit nonamnestic deficits in cognitive domains such as executive function, attention, and visuospatial function; however, the cognitive phenotype of PD-MCI is heterogeneous with some patients demonstrating greater amnestic deficits. PD-MCI patients, particularly those with posterior cortical profiles, may be at high risk for developing dementia. Various biomarkers studied in PD-MCI including cerebrospinal fluid, genetic analyses, and neuroimaging suggest that there may be distinct PD-MCI profiles. Future studies using uniform PD-MCI diagnostic criteria and incorporating biomarkers and longitudinal follow-up of PD-MCI cohorts are needed to understand PD-MCI as a transitional state between normal cognition and dementia. PMID:22193376

  9. Citicoline in vascular cognitive impairment and vascular dementia after stroke.

    PubMed

    Alvarez-Sabín, Jose; Román, Gustavo C

    2011-01-01

    Cognitive decline after stroke is more common than stroke recurrence. Stroke doubles the risk of dementia and is a major contributor to vascular cognitive impairment and vascular dementia. Neuropathological studies in most cases of dementia in the elderly reveal a large load of vascular ischemic brain lesions mixed with a lesser contribution of neurodegenerative lesions of Alzheimer disease. Nonetheless, few pharmacological studies have addressed vascular cognitive impairment and vascular dementia after stroke. Citicoline has demonstrated neuroprotective effects in acute stroke and has been shown to improve cognition in patients with chronic cerebrovascular disease and in some patients with Alzheimer disease. A recent trial lasting 6 months in patients with first-ever ischemic stroke showed that citicoline prevented cognitive decline after stroke with significant improvement of temporal orientation, attention, and executive function. Experimentally, citicoline exhibits neuroprotective effects and enhances neural repair. Citicoline appears to be a safe and promising alternative to improve stroke recovery and could be indicated in patients with vascular cognitive impairment, vascular dementia, and Alzheimer disease with significant cerebrovascular disease.

  10. Cognitive Impairment and Rehabilitation Strategies After Traumatic Brain Injury.

    PubMed

    Barman, Apurba; Chatterjee, Ahana; Bhide, Rohit

    2016-01-01

    Traumatic brain injury (TBI) is among the significant causes of morbidity and mortality in the present world. Around 1.6 million persons sustain TBI, whereas 200,000 die annually in India, thus highlighting the rising need for appropriate cognitive rehabilitation strategies. This literature review assesses the current knowledge of various cognitive rehabilitation training strategies. The entire spectrum of TBI severity; mild to severe, is associated with cognitive deficits of varying degree. Cognitive insufficiency is more prevalent and longer lasting in TBI persons than in the general population. A multidisciplinary approach with neuropsychiatric evaluation is warranted. Attention process training and tasks for attention deficits, compensatory strategies and errorless learning training for memory deficits, pragmatic language skills and social behavior guidance for cognitive-communication disorder, meta-cognitive strategy, and problem-solving training for executive disorder are the mainstay of therapy for cognitive deficits in persons with TBI. Cognitive impairments following TBI are common and vary widely. Different cognitive rehabilitation techniques and combinations in addition to pharmacotherapy are helpful in addressing various cognitive deficits.

  11. Cognitive Impairment and Rehabilitation Strategies After Traumatic Brain Injury

    PubMed Central

    Barman, Apurba; Chatterjee, Ahana; Bhide, Rohit

    2016-01-01

    Traumatic brain injury (TBI) is among the significant causes of morbidity and mortality in the present world. Around 1.6 million persons sustain TBI, whereas 200,000 die annually in India, thus highlighting the rising need for appropriate cognitive rehabilitation strategies. This literature review assesses the current knowledge of various cognitive rehabilitation training strategies. The entire spectrum of TBI severity; mild to severe, is associated with cognitive deficits of varying degree. Cognitive insufficiency is more prevalent and longer lasting in TBI persons than in the general population. A multidisciplinary approach with neuropsychiatric evaluation is warranted. Attention process training and tasks for attention deficits, compensatory strategies and errorless learning training for memory deficits, pragmatic language skills and social behavior guidance for cognitive-communication disorder, meta-cognitive strategy, and problem-solving training for executive disorder are the mainstay of therapy for cognitive deficits in persons with TBI. Cognitive impairments following TBI are common and vary widely. Different cognitive rehabilitation techniques and combinations in addition to pharmacotherapy are helpful in addressing various cognitive deficits. PMID:27335510

  12. Treatment of cognitive impairment in Alzheimer's disease

    PubMed Central

    Burns, Alistair

    2003-01-01

    In Alzheimer's disease, cognition now responds to several drugs. Anticholinesterases target the acetylcholine deficit. In mild-to-moderate Alzheimer's disease, they all provide significant benefit versus placebo on the Alzheimer's Disease Assessment ScheduleCognitive Section (ADAS-Cog), Side effects, in 5% to 15% of cases, include nausea, vomiting, diarrhea, anorexia, and dizziness. Tacrine, the leading anticholinesterase, caused frequent hepatic enzyme elevation and was withdrawn; once-daily donepezil spares the liver and improves global measures of change in severe dementia; rivasiigmine is indicated in comorbid vascular disease; while galaniamine modulates the cerebral nicotinic acetylcholine receptors that potentiate the response to acetylcholine. Alternative agents include the N-methyl-D-aspartate (NMDA) receptor antagonist, memaniine, licensed in Europe for moderately severe to severe Alzheimer's disease; it acts on a different neurotransmitter system present in 70% of neurons, protecting against pathologic glutamergic activation while preserving or even restoring physiologic glutamergic activation. The clinician's armamentarium in AD has never been greater. PMID:22034058

  13. Epilepsy and cognitive impairments in Alzheimer disease.

    PubMed

    Palop, Jorge J; Mucke, Lennart

    2009-04-01

    Alzheimer disease (AD) is associated with cognitive decline and increased incidence of seizures. Seizure activity in AD has been widely interpreted as a secondary process resulting from advanced stages of neurodegeneration, perhaps in combination with other age-related factors. However, recent findings in animal models of AD have challenged this notion, raising the possibility that aberrant excitatory neuronal activity represents a primary upstream mechanism that may contribute to cognitive deficits in these models. The following observations suggest that such activity may play a similar role in humans with AD: (1) patients with sporadic AD have an increased incidence of seizures that appears to be independent of disease stage and highest in cases with early onset; (2) seizures are part of the natural history of many pedigrees with autosomal dominant early-onset AD, including those with mutations in presenilin-1, presenilin-2, or the amyloid precursor protein, or with duplications of wild-type amyloid precursor protein; (3) inheritance of the major known genetic risk factor for AD, apolipoprotein E4, is associated with subclinical epileptiform activity in carriers without dementia; and (4) some cases of episodic amnestic wandering and disorientation in AD are associated with epileptiform activity and can be prevented with antiepileptic drugs. Here we review recent experimental data demonstrating that high levels of beta-amyloid in the brain can cause epileptiform activity and cognitive deficits in transgenic mouse models of AD. We conclude that beta-amyloid peptides may contribute to cognitive decline in AD by eliciting similar aberrant neuronal activity in humans and discuss potential clinical and therapeutic implications of this hypothesis.

  14. Epilepsy and Cognitive Impairments in Alzheimer Disease

    PubMed Central

    Palop, Jorge J.; Mucke, Lennart

    2010-01-01

    Summary Alzheimer disease (AD) is associated with cognitive decline and increased incidence of seizures. Seizure activity in AD has been widely interpreted as a secondary process resulting from advanced stages of neurodegeneration, perhaps in combination with other age-related factors. However, recent findings in animal models of AD have challenged this notion, raising the possibility that aberrant excitatory neuronal activity represents a primary upstream mechanism that may contribute to cognitive deficits in these models. The following observations suggest that such activity may play a similar role in humans with AD: (1) patients with sporadic AD have an increased incidence of seizures that appears to be independent of disease stage and highest in cases with early onset; (2) seizures are part of the natural history of many pedigrees with autosomal dominant early-onset AD, including those with mutations in presenilin-1, presenilin-2, or the amyloid precursor protein, or with duplications of wild-type amyloid precursor protein; (3) inheritance of the major known genetic risk factor for AD, apolipoprotein E4, is associated with subclinical epileptiform activity in carriers without dementia; and (4) some cases of episodic amnestic wandering and disorientation in AD are associated with epileptiform activity and can be prevented with antiepileptic drugs. Here we review recent experimental data demonstrating that high levels of β-amyloid in the brain can cause epileptiform activity and cognitive deficits in transgenic mouse models of AD. We conclude that β-amyloid peptides may contribute to cognitive decline in AD by eliciting similar aberrant neuronal activity in humans and discuss potential clinical and therapeutic implications of this hypothesis. PMID:19204149

  15. Predicting cognitive impairment and accident risk.

    PubMed

    Raslear, Thomas G; Hursh, Steven R; Van Dongen, Hans P A

    2011-01-01

    Sleep and cognition are temporally regulated by a homeostatic process generating pressure for sleep as a function of sleep/wake history, and a circadian process generating pressure for wakefulness as a function of time of day. Under normal nocturnal sleep conditions, these two processes are aligned in such a manner as to provide optimal daytime performance and consolidated nighttime sleep. Under conditions of sleep deprivation, shift work or transmeridian travel, the two processes are misaligned, resulting in fatigue and cognitive deficits. Mathematical models of fatigue and performance have been developed to predict these cognitive deficits. Recent studies showing long-term effects on performance of chronic sleep restriction suggest that the homeostatic process undergoes gradual changes that are slow to recover. New developments in mathematical modeling of performance are focused on capturing these gradual changes and their effects on fatigue. Accident risk increases as a function of fatigue severity as well as the duration of exposure to fatigue. Work schedule and accident rate information from an operational setting can thus be used to calibrate a mathematical model of fatigue and performance to predict accident risk. This provides a fatigue risk management tool that helps to direct mitigation resources to where they would have the greatest mitigating effect. Copyright © 2011 Elsevier B.V. All rights reserved.

  16. Edaravone attenuates intracerebroventricular streptozotocin-induced cognitive impairment in rats.

    PubMed

    Reeta, K H; Singh, Devendra; Gupta, Yogendra K

    2017-02-15

    Alzheimer's disease is a major cause of dementia worldwide. Edaravone, a potent free radical scavenger, is reported to be neuroprotective. The present study was designed to investigate the effect of chronic edaravone administration on intracerebroventricular-streptozotocin (ICV-STZ) induced cognitive impairment in male Wistar rats. Cognitive impairment was developed by single ICV-STZ (3 mg/kg) injection bilaterally on day 1. Edaravone (1, 3 and 10 mg/kg, orally, once daily) was administered for 28 days. Morris water maze and passive avoidance tests were used to assess cognitive functions at baseline and on days 14 and 28. ICV-STZ caused cognitive impairment as evidenced by increased escape latency and decreased time spent in target quadrant in the Morris water maze test and reduced retention latency in the passive avoidance test. STZ caused increase in oxidative stress, cholinesterases, inflammatory cytokines and protein expression of ROCK-II and decrease in protein expression of ChAT. Edaravone ameliorated the STZ-induced cognitive impairment. STZ-induced increase in oxidative stress and increased levels of pro-inflammatory cytokines (TNF-α, IL-1β) were mitigated by edaravone. Edaravone also prevented STZ-induced increased protein expression of ROCK-II. Moreover, edaravone significantly prevented STZ-induced increased activity of cholinesterases in the cortex and hippocampus. The decreased expression of ChAT caused by STZ was brought towards normal by edaravone in the hippocampus. The results thus show that edaravone is protective against STZ-induced cognitive impairment, oxidative stress, cholinergic dysfunction and altered protein expressions. This study thus suggests the potential of edaravone as an adjuvant in the treatment of Alzheimer's disease.

  17. Alcohol screening in people with cognitive impairment: an exploratory study.

    PubMed

    Randall-James, James; Wadd, Sarah; Edwards, Kim; Thake, Anna

    2015-01-01

    Alcohol misuse can coexist with and/or contribute to the development of cognitive impairment in the older adult population but continues to be underestimated and undetected in older people. This study aimed to examine the feasibility and acceptability of routine screening for alcohol misuse in a small sample of older people with cognitive impairment receiving services in memory clinics. This study employed a qualitative and exploratory design, using a convenience sample of individuals attending a memory clinic in England. Ten service users older than 65 with a diagnosis of cognitive impairment (i.e., mild cognitive impairment or dementia) took part in the study. Individuals who met inclusion criteria were invited to take part in an hour-long interview, which included the interviewer administering the alcohol screening tools. Interview transcripts were analyzed using thematic analysis. Participants were able to engage with the screening tools and could, with assistance, complete them in a collaborative and timely manner without distress. All participants reported that these tools were acceptable as part of the clinic assessment. Administering the screening tools was not time-consuming or difficult, making their use feasible within the memory clinic setting. While there were some challenges (e.g., arithmetic, recall, language problems), these challenges could be overcome with the aid of the person administering the screening tool using standardized techniques for assessment administration. Routine screening for alcohol misuse in older people with cognitive impairment receiving services in memory clinics is feasible and acceptable. The process of completing alcohol screening tools with older adults receiving services at memory clinics may increase awareness of the potential impact of alcohol on cognitive functioning and provide practitioners with an opportunity to educate service users about the ways that their drinking is affecting their memory. Several techniques to

  18. Dementia and cognitive impairment: epidemiology, diagnosis, and treatment.

    PubMed

    Hugo, Julie; Ganguli, Mary

    2014-08-01

    Symptoms of memory loss are caused by a range of cognitive abilities or a general cognitive decline, and not just memory. Clinicians can diagnose the syndromes of dementia (major neurocognitive disorder) and mild cognitive impairment (mild neurocognitive disorder) based on history, examination, and appropriate objective assessments, using standard criteria such as Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. They can then diagnose the causal subtypes of these syndromes using standard criteria for each of them. Brain imaging and biomarkers are making progress in the differential diagnoses among the different disorders. Treatments are still mostly symptomatic.

  19. Cognitive Processes of Numerical Estimation in Children

    ERIC Educational Resources Information Center

    Ashcraft, Mark H.; Moore, Alex M.

    2012-01-01

    We tested children in Grades 1 to 5, as well as college students, on a number line estimation task and examined latencies and errors to explore the cognitive processes involved in estimation. The developmental trends in estimation were more consistent with the hypothesized shift from logarithmic to linear representation than with an account based…

  20. Cognitive Processes of Numerical Estimation in Children

    ERIC Educational Resources Information Center

    Ashcraft, Mark H.; Moore, Alex M.

    2012-01-01

    We tested children in Grades 1 to 5, as well as college students, on a number line estimation task and examined latencies and errors to explore the cognitive processes involved in estimation. The developmental trends in estimation were more consistent with the hypothesized shift from logarithmic to linear representation than with an account based…

  1. Cognitive Dimensions of Numerical Rule Induction.

    ERIC Educational Resources Information Center

    Holzman, Thomas G.; And Others

    1982-01-01

    Developmental differences in reasoning ability and item processing demands are analyzed in a study of cognitive determinants of number analogy performance in two IQ levels of elementary school children and college students. The amount of solution-related information in working memory was the crucial processing demand. Process differentiations of…

  2. Phenotypic cognitive impairment in late-onset delusional disorder.

    PubMed

    Harris, Ben S; Kotsopoulos, Eleftheria J; Yamin, Sami

    2014-06-01

    Previous use of heterogeneous diagnostic criteria and insensitive cognitive measures has impeded clarification of the extent and type of cognitive impairment specific to late-onset delusional disorder. We examined whether clinical presentations of late-onset delusional disorder are associated with prodromal or established dementia, and whether it might be a discrete clinical syndrome characterized by its own profile of cognitive impairment. Nineteen patients with late-onset delusional disorder from a hospital psychiatric service and 20 patients with dementia of the Alzheimer's type (AD) from an outpatient memory clinic were recruited in a consecutive case series. All patients underwent comprehensive neuropsychological assessment that included general intellectual function, executive function, new learning and delayed memory, language, processing speed, and visuo-perceptual skills. Late-onset delusional disorder patients showed moderate impairment to conceptual reasoning, visual object recognition, processing speed, and confrontation naming. Severe impairment appeared in visuo-perceptual planning and organization, and divided attention. Compared with the Alzheimer's disease (AD) group, the late-onset delusional disorder group demonstrated significantly poorer visuo-perceptual skills but a significantly better capacity to consolidate information into delayed memory. A high rate of marked cognitive impairment occurs in late-onset delusional disorder. There was evidence of a conceptual reasoning deficit, plus the presence of a visuo-perceptual impairment affecting object recognition. This impairment profile can explain the genesis and maintenance of the observed delusions. Understanding late-onset delusional disorder as other than a purely psychiatric phenomenon or a precursor to AD will lead to better assessment and management approaches.

  3. Cognitive impairment in degenerative parkinsonisms: role of radionuclide brain imaging.

    PubMed

    Arnaldi, D; Morbelli, S; Morrone, E; Campus, C; Nobili, Flavio

    2012-02-01

    Cognitive impairment in Parkinson's disease (PD) and atypical parkinsonian syndromes is gaining increased clinical significance. The neurochemical and neuropathological basis in the various parkinsonian forms and even in an individual patient are not fully elucidated yet and could be heterogeneous. Loss of dopaminergic, cholinergic and noradrenergic innervation has been suggested to be the underlying neurochemical deficits for cognitive impairment and dementia in PD, but the onset of cognitive impairment and the progression to dementia may not share the same underlying neurochemical basis. Similarly, pathological evidence is also heterogeneous, ranging from subcortical pathology, limbic or cortical Lewy body type degeneration, and Alzheimer's type pathology that can be found even in the same patient with PD dementia (PDD). Typically, the prototype of early cognitive deficit in PD is a dysexecutive syndrome, but other cognitive domains are more involved when dementia develops, mainly including visuospatial, language and memory dysfunction. Functional radionuclide neuroimaging, by means of single-photon emission computed tomography and positron emission tomography, are contributing to characterize the topographic cortical pattern of cognitive impairment, as well as to define the underlying neurochemical deficit. Lastly, the advent of amyloid PET may help clarifying the meaning of amyloid load in diffuse Lewy body disease and PDD. Knowing the neurochemical and pathophysiological substrate of cognitive deficit in patients with PD or other degenerative Parkinsonisms may help the clinician in understanding the clinical condition of an individual patient in order to plan pharmacological and non-pharmacological intervention. The introduction of acetylcholinesterase inhibitors for therapy of PDD is an example of information integration between clinical-neuropsychological and pathophysiological-neurochemical aspects obtained also with the key contribution of functional

  4. Subjective cognitive impairment: Towards early identification of Alzheimer disease.

    PubMed

    Garcia-Ptacek, S; Eriksdotter, M; Jelic, V; Porta-Etessam, J; Kåreholt, I; Manzano Palomo, S

    2016-10-01

    Neurodegeneration in Alzheimer disease (AD) begins decades before dementia and patients with mild cognitive impairment (MCI) already demonstrate significant lesion loads. Lack of information about the early pathophysiology in AD complicates the search for therapeutic strategies.Subjective cognitive impairment is the description given to subjects who have memory-related complaints without pathological results on neuropsychological tests. There is no consensus regarding this heterogeneous syndrome, but at least some of these patients may represent the earliest stage in AD. We reviewed available literature in order to summarise current knowledge on subjective cognitive impairment. Although they may not present detectable signs of disease, SCI patients as a group score lower on neuropsychological tests than the general population does, and they also have a higher incidence of future cognitive decline. Depression and psychiatric co-morbidity play a role but cannot account for all cognitive complaints. Magnetic resonance imaging studies in these patients reveal a pattern of hippocampal atrophy similar to that of amnestic mild cognitive impairment and functional MRI shows increased activation during cognitive tasks which might indicate compensation for loss of function. Prevalence of an AD-like pattern of beta-amyloid (Aβ42) and tau proteins in cerebrospinal fluid is higher in SCI patients than in the general population. Memory complaints are relevant symptoms and may predict AD. Interpatient variability and methodological differences between clinical studies make it difficult to assign a definition to this syndrome. In the future, having a standard definition and longitudinal studies with sufficient follow-up times and an emphasis on quantifiable variables may clarify aspects of early AD. Copyright © 2012 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Inflammatory mediators of cognitive impairment in bipolar disorder

    PubMed Central

    Bauer, Isabelle E.; Pascoe, Michaela C.; Wollenhaupt-Aguiar, Bianca; Kapczinski, Flavio; Soares, Jair C.

    2014-01-01

    Objectives Recent studies have pointed to neuroinflammation, oxidative stress and neurotrophic factors as key mediators in the pathophysiology of mood disorders. Little is however known about the cascade of biological episodes underlying the cognitive deficits observed during the acute and euthymic phases of bipolar disorder (BD). The aim of this review is to assess the potential association between cognitive impairment and biomarkers of inflammation, oxidative stress and neurotrophic activity in BD. Methods Scopus (all databases), Pubmed and Ovid Medline were systematically searched with no language or year restrictions, up to November 2013, for human studies that collected both inflammatory markers and cognitive data in BD. Selected search terms were bipolar disorder, depression, mania, psychosis, inflammatory, cognitive and neurotrophic. Results Ten human studies satisfied the criteria for consideration. The findings showed that high levels of peripheral inflammatory-cytokine, oxidative stress and reduced brain derived neurotrophic factor (BDNF) levels were associated with poor cognitive performance. The BDNF val66met polymorphism is a potential vulnerability factor for cognitive impairment in BD. Conclusions Current data provide preliminary evidence of a link between the cognitive decline observed in BD and mechanisms of neuroinflammation and neuroprotection. The identification of BD specific inflammatory markers and polymorphisms in inflammatory response genes may be of assistance for therapeutic intervention. PMID:24862657

  6. Correlation between functional mobility and cognitive performance in older adults with cognitive impairment.

    PubMed

    Borges, Sheila de Melo; Radanovic, Márcia; Forlenza, Orestes Vicente

    2016-12-09

    Association between cognitive impairment and gait performance occurs in mild cognitive impairment (MCI) and Alzheimer's disease (AD), particularly under "divided attention" conditions, leading to a greater risk of falls. We studied 36 controls, 42 MCI, and 26 mild AD patients, using the Timed Up-and-Go test (TUG) under four conditions: TUG single - TUG1; TUG cognitive - TUG2; TUG manual -TUG3; TUG cognitive and manual - TUG4. Cognition was assessed using the MMSE, SKT, Exit25, and TMT (A and B). We found significant correlations between cognitive scores and TUG2 [r values (MMSE: -0.383, TMT-A: 0.430, TMT-B: 0.386, Exit25: 0.455, SKT: 0.563)] and TUG4 [(MMSE: -0.398, TMT-A: 0.384, TMT-B: 0.352,Exit25: 0.466, SKT: 0.525)] in the AD group, and between all TUG modalities and SKT in MCI and AD. Our results revealed that functional mobility impairment in cognitive dual tasks correlated to cognitive decline in AD patients and to attention and memory impairment in MCI.

  7. Dietary Patterns Are Associated with Cognition among Older People with Mild Cognitive Impairment

    PubMed Central

    Torres, Susan J.; Lautenschlager, Nicola T.; Wattanapenpaiboon, Naiyana; Greenop, Kathryn R.; Beer, Christopher; Flicker, Leon; Alfonso, Helman; Nowson, Caryl A.

    2012-01-01

    There has been increasing interest in the influence of diet on cognition in the elderly. This study examined the cross-sectional association between dietary patterns and cognition in a sample of 249 people aged 65–90 years with mild cognitive impairment (MCI). Two dietary patterns; whole and processed food; were identified using factor analysis from a 107-item; self-completed Food Frequency Questionnaire. Logistic regression analyses showed that participants in the highest tertile of the processed food pattern score were more likely to have poorer cognitive functioning; in the lowest tertile of executive function (OR 2.55; 95% CI: 1.08–6.03); as assessed by the Cambridge Cognitive Examination. In a group of older people with MCI; a diet high in processed foods was associated with some level of cognitive impairment. PMID:23201831

  8. Different Patterns of Theory of Mind Impairment in Mild Cognitive Impairment.

    PubMed

    Moreau, Noémie; Rauzy, Stéphane; Bonnefoi, Bernadette; Renié, Laurent; Martinez-Almoyna, Laurent; Viallet, François; Champagne-Lavau, Maud

    2015-01-01

    Theory of Mind refers to the ability to infer other’s mental states, their beliefs, intentions, or knowledge. To date, only two studies have reported the presence of Theory of Mind impairment in mild cognitive impairment (MCI). In the present study,we evaluated 20 MCI patients and compared them with 25 healthy control participants using two Theory of Mind tasks. The first task was a false belief paradigm as frequently used in the literature, and the second one was a referential communication task,assessing Theory of Mind in a real situation of interaction and which had never been used before in this population. The results showed that MCI patients presented difficulties inferring another person’s beliefs about reality and attributing knowledge to them in a situation of real-life interaction. Two different patterns of Theory of Mind emerged among the patients. In comparison with the control group, some MCI patients demonstrated impairment only in the interaction task and presented isolated episodicmemory impairment, while others were impaired in both Theory of Mind tasks and presented cognitive impairment impacting both episodic memory and executive functioning. Theory of Mind is thus altered in the very early stages of cognitive impairment even in real social interaction, which could impact precociously relationships in daily life.

  9. A methodology for the characterization and diagnosis of cognitive impairments-Application to specific language impairment.

    PubMed

    Oliva, Jesús; Serrano, J Ignacio; del Castillo, M Dolores; Iglesias, Angel

    2014-06-01

    The diagnosis of mental disorders is in most cases very difficult because of the high heterogeneity and overlap between associated cognitive impairments. Furthermore, early and individualized diagnosis is crucial. In this paper, we propose a methodology to support the individualized characterization and diagnosis of cognitive impairments. The methodology can also be used as a test platform for existing theories on the causes of the impairments. We use computational cognitive modeling to gather information on the cognitive mechanisms underlying normal and impaired behavior. We then use this information to feed machine-learning algorithms to individually characterize the impairment and to differentiate between normal and impaired behavior. We apply the methodology to the particular case of specific language impairment (SLI) in Spanish-speaking children. The proposed methodology begins by defining a task in which normal and individuals with impairment present behavioral differences. Next we build a computational cognitive model of that task and individualize it: we build a cognitive model for each participant and optimize its parameter values to fit the behavior of each participant. Finally, we use the optimized parameter values to feed different machine learning algorithms. The methodology was applied to an existing database of 48 Spanish-speaking children (24 normal and 24 SLI children) using clustering techniques for the characterization, and different classifier techniques for the diagnosis. The characterization results show three well-differentiated groups that can be associated with the three main theories on SLI. Using a leave-one-subject-out testing methodology, all the classifiers except the DT produced sensitivity, specificity and area under curve values above 90%, reaching 100% in some cases. The results show that our methodology is able to find relevant information on the underlying cognitive mechanisms and to use it appropriately to provide better

  10. Epidemiology of Osteoporosis in Women with Cognitive Impairment

    ERIC Educational Resources Information Center

    Schrager, Sarina

    2006-01-01

    Osteoporosis is increasing due to the aging of the population. Women with cognitive impairment from childhood are at disproportionally high risk for osteoporosis and fractures. Suggested explanations for this increased risk include high use of anticonvulsant medications, lower peak bone densities, and higher rates of nonambulation. Down syndrome…

  11. Epidemiology of Osteoporosis in Women with Cognitive Impairment

    ERIC Educational Resources Information Center

    Schrager, Sarina

    2006-01-01

    Osteoporosis is increasing due to the aging of the population. Women with cognitive impairment from childhood are at disproportionally high risk for osteoporosis and fractures. Suggested explanations for this increased risk include high use of anticonvulsant medications, lower peak bone densities, and higher rates of nonambulation. Down syndrome…

  12. Distinct Mechanisms of Impairment in Cognitive Ageing and Alzheimer's Disease

    ERIC Educational Resources Information Center

    Mapstone, Mark; Dickerson, Kathryn; Duffy, Charles J.

    2008-01-01

    Similar manifestations of functional decline in ageing and Alzheimer's disease obscure differences in the underlying cognitive mechanisms of impairment. We sought to examine the contributions of top-down attentional and bottom-up perceptual factors to visual self-movement processing in ageing and Alzheimer's disease. We administered a novel…

  13. Nonlinguistic Cognitive Treatment for Bilingual Children with Primary Language Impairment

    ERIC Educational Resources Information Center

    Ebert, Kerry Danahy; Rentmeester-Disher, Jill; Kohnert, Kathryn

    2012-01-01

    Substantial evidence points to the presence of subtle weaknesses in the nonlinguistic cognitive processing skills of children with primary (or specific) language impairment (PLI). It is possible that these weaknesses contribute to the language learning difficulties that characterize PLI, and that treating them can improve language skills. To test…

  14. Nonlinguistic Cognitive Treatment for Bilingual Children with Primary Language Impairment

    ERIC Educational Resources Information Center

    Ebert, Kerry Danahy; Rentmeester-Disher, Jill; Kohnert, Kathryn

    2012-01-01

    Substantial evidence points to the presence of subtle weaknesses in the nonlinguistic cognitive processing skills of children with primary (or specific) language impairment (PLI). It is possible that these weaknesses contribute to the language learning difficulties that characterize PLI, and that treating them can improve language skills. To test…

  15. Distinct Mechanisms of Impairment in Cognitive Ageing and Alzheimer's Disease

    ERIC Educational Resources Information Center

    Mapstone, Mark; Dickerson, Kathryn; Duffy, Charles J.

    2008-01-01

    Similar manifestations of functional decline in ageing and Alzheimer's disease obscure differences in the underlying cognitive mechanisms of impairment. We sought to examine the contributions of top-down attentional and bottom-up perceptual factors to visual self-movement processing in ageing and Alzheimer's disease. We administered a novel…

  16. Care Partner Responses to the Onset of Mild Cognitive Impairment

    ERIC Educational Resources Information Center

    Blieszner, Rosemary; Roberto, Karen A.

    2010-01-01

    Purpose: We examined characteristics, responses, and psychological well-being of care partners who support and assist older adults recently diagnosed with mild cognitive impairment (MCI). Design and Methods: Based on a sample of 106 care partners of community residents diagnosed with MCI at memory clinics, we conducted face-to-face interviews…

  17. Nutritional risk and cognitive impairment in the elderly.

    PubMed

    Lee, Kang Soo; Cheong, Hae-Kwan; Kim, Eun A; Kim, Kyung Ran; Oh, Byoung Hoon; Hong, Chang Hyung

    2009-01-01

    The purpose of this study was to determine the relationship between nutritional risk and cognitive impairment in the elderly living in the community. Data obtained from 2934 subjects (912 men and 2022 women) aged above 60 years was analyzed from the Gwangju Dementia and Mild Cognitive Impairment Study (GDEMCIS). The study questionnaire comprised demographic characteristics, history of current and past illnesses, drug history, Korean version-Mini Mental State Examination (K-MMSE), and Nutritional Screening Initiative (NSI) checklist. Additionally, we examined the blood pressure, fasting serum glucose level, lipid profile, body mass index, and ApoE genotype. Of the total, 1942 (66.2%) demonstrated good nutritional state (NSI checklist score< or =2) and 992 (33.8%) were at moderate or high nutritional risk (NSI checklist score>2). Multiple logistic regression analysis revealed that moderate or high nutritional risk subjects were associated with an increased risk of cognitive impairment (K-MMSE score< or =17) after adjustment for age, sex, educational level, and Korean version of Short form Geriatric Depression Scale (K-SGDS) score (Odds ratio=OR=1.71, 95%; confidence interval=CI=1.17-2.50). These results suggest that nutritional risk may be associated with cognitive impairment in the elderly.

  18. Care Partner Responses to the Onset of Mild Cognitive Impairment

    ERIC Educational Resources Information Center

    Blieszner, Rosemary; Roberto, Karen A.

    2010-01-01

    Purpose: We examined characteristics, responses, and psychological well-being of care partners who support and assist older adults recently diagnosed with mild cognitive impairment (MCI). Design and Methods: Based on a sample of 106 care partners of community residents diagnosed with MCI at memory clinics, we conducted face-to-face interviews…

  19. Buspirone for stereotypic movements in elderly with cognitive impairment.

    PubMed

    Helvink, Badalin; Holroyd, Suzanne

    2006-01-01

    Repetitive and stereotypic behavioral disturbances in patients with dementia are common; however, little is known regarding successful treatments. The authors describe six cases of elderly cognitively impaired patients exhibiting repetitive and stereotypic behaviors who were treated successfully with buspirone. The cases demonstrate that buspirone may be an effective and safe treatment for patients with dementia who demonstrate repetitive and stereotypic behavior disorders.

  20. Combining Cognitive Screening Tests for the Evaluation of Mild Cognitive Impairment in the Elderly

    PubMed Central

    Ladeira, Rodolfo B.; Diniz, Breno S.; Nunes, Paula V.; Forlenza, Orestes V.

    2009-01-01

    OBJECTIVE To determine the accuracy of the Mini-Mental State Examination combined with the Verbal Fluency Test and Clock Drawing Test for the identification of patients with mild cognitive impairment and Alzheimer’s disease (AD). METHOD These tests were used to evaluate cognitive function in 247 older adults. Subjects were divided into three groups according to their cognitive state: mild cognitive impairment (n=83), AD (n=81), cognitively unimpaired controls (n=83), based on clinical and neuropsychological data. The diagnostic accuracy of each test for discriminating between these diagnostic groups (mild cognitive impairment or AD vs. controls) was examined with the aid of Receiver Operating Characteristic (ROC) curves. Additionally, we evaluated the benefit of the combination of tests on diagnostic accuracy. RESULTS Although they were accurate enough for the identification of Alzheimer’s disease, neither test alone proved adequate for the correct separation of patients with mild cognitive impairment from healthy subjects. Combining these tests did not improve diagnostic accuracy, as compared to the Mini-Mental State Examination alone, in the identification of patients with mild cognitive impairment or Alzheimer’s disease. CONCLUSIONS The present data do not warrant the combined use of the Mini-Mental State Examination, the Verbal Fluency Test and the Clock Drawing Test as a sufficient diagnostic schedule in screening for mild cognitive impairment. The present data do not support the notion that the combination of test scores is better that the use of Mini-Mental State Examination scores alone in the screening for Alzheimer’s disease. PMID:19841703

  1. [Alcohol-related cognitive impairment and the DSM-5].

    PubMed

    Walvoort, S J W; Wester, A J; Doorakkers, M C; Kessels, R P C; Egger, J I M

    2016-01-01

    It is evident from the dsm-iv-tr that alcohol-related impairment is extremely difficult to classify accurately. As a result, cognitive deficits can easily be overlooked. The dsm-5, however, incorporates a new category, namely 'neurocognitive disorders', which may lead to significant improvements in clinical practice. To compare the classification of alcohol-related cognitive dysfunction in dsm-iv-tr and dsm-5 and to discuss the clinical relevance of the revised classification in the dsm-5. We compare the chapters of the dsm-iv-tr and the dsm-5 concerning alcohol-related cognitive impairment and describe the changes that have been made. The dsm-5 puts greater emphasis on alcohol-related neurocognitive impairment. Not only does dsm-5 distinguish between the degree of severity (major or minor neurocognitive disorder), it also distinguishes between the type of impairment (non-amnestic-type versus confabulating-amnestic type). It also makes a distinction between the durations of impairment (behavioural and/or persistent disorders). The dsm-5 gives a clearer description of alcohol-related neurocognitive dysfunction than does dsm-iv-tr and it stresses the essential role of neuropsychological assessment in the classification, diagnosis, and treatment of neurocognitive disorders.

  2. Hyperbaric oxygen preconditioning attenuates postoperative cognitive impairment in aged rats.

    PubMed

    Sun, Li; Xie, Keliang; Zhang, Changsheng; Song, Rui; Zhang, Hong

    2014-06-18

    Cognitive decline after surgery in the elderly population is a major clinical problem with high morbidity. Hyperbaric oxygen (HBO) preconditioning can induce significant neuroprotection against acute neurological injury. We hypothesized that HBO preconditioning would prevent the development of postoperative cognitive impairment. Elderly male rats (20 months old) underwent stabilized tibial fracture operation under general anesthesia after HBO preconditioning (once a day for 5 days). Separate cohorts of animals were tested for cognitive function with fear conditioning and Y-maze tests, or euthanized at different times to assess the blood-brain barrier integrity, systemic and hippocampal proinflammatory cytokines, and caspase-3 activity. Animals exhibited significant cognitive impairment evidenced by a decreased percentage of freezing time and an increased number of learning trials on days 1, 3, and 7 after surgery, which were significantly prevented by HBO preconditioning. Furthermore, HBO preconditioning significantly ameliorated the increase in serum and hippocampal proinflammatory cytokines tumor necrosis factor-α, interleukin-1 β (IL-1β), IL-6, and high-mobility group protein 1 in surgery-challenged animals. Moreover, HBO preconditioning markedly improved blood-brain barrier integrity and caspase-3 activity in the hippocampus of surgery-challenged animals. These findings suggest that HBO preconditioning could significantly mitigate surgery-induced cognitive impairment, which is strongly associated with the reduction of systemic and hippocampal proinflammatory cytokines and caspase-3 activity.

  3. [Cognitive impairments in alcohol dependence: From screening to treatment improvements].

    PubMed

    Cabé, N; Laniepce, A; Ritz, L; Lannuzel, C; Boudehent, C; Vabret, F; Eustache, F; Beaunieux, H; Pitel, A-L

    2016-02-01

    Alcohol-related cognitive impairments are largely underestimated in clinical practice, even though they could limit the benefit of alcohol treatment and hamper the patient's ability to remain abstinent or to respect his/her therapeutic contract. These neuropsychological deficits can impact the management of patients well before the development of the well-known Korsakoff's syndrome. Indeed, even in the absence of ostensible neurological complications, excessive and chronic alcohol consumption results in damage of brain structure and function. The frontocerebellar circuit and the circuit of Papez, respectively involved in motor and executive abilities and episodic memory, are mainly affected. Those brain dysfunctions are associated with neuropsychological deficits, including deficits of executive functions, episodic memory, social cognition, as well as visuospatial and motor abilities. Such cognitive disorders can interfere with the motivation process to abandon maladjusted drinking behavior in favor of a healthier lifestyle (such as abstinence or controlled alcohol consumption). They can also limit the patient's capacity to fully benefit from treatment (notably psychoeducation and cognitive-behavioural treatments) currently widely proposed in French Addiction departments. In addition, they may contribute to relapse which is multi-determinated. A neuropsychological assessment appears therefore crucial to take relevant clinical decisions. However, very few addiction departments have the human and financial resources to conduct an extensive neuropsychological examination of all patients with alcohol dependence. Some brief screening tools can be used, notably the MOntreal Cognitive Assessment and the Brief Evaluation of Alcohol-Related Neuropsychological Impairments, which has been especially designed to assess cognitive and motor deficits in alcoholism. These tools can be used by non-psychologist clinicians to detect alcohol-related cognitive deficits, which require

  4. Process quality indicators targeting cognitive impairment to support quality of care for older people with cognitive impairment in emergency departments.

    PubMed

    Schnitker, Linda M; Martin-Khan, Melinda; Burkett, Ellen; Beattie, Elizabeth R A; Jones, Richard N; Gray, Len C

    2015-03-01

    The objective of this study was to develop process quality indicators (PQIs) to support the improvement of care services for older people with cognitive impairment in emergency departments (ED). A structured research approach was taken for the development of PQIs for the care of older people with cognitive impairment in EDs, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and formal voting (phase 3). A systematic review of the literature identified ED processes targeting the specific care needs of older people with cognitive impairment. Existing relevant PQIs were also included. By integrating the scientific evidence and clinical expertise, new PQIs were drafted and, along with the existing PQIs, extensively discussed by an advisory panel. These indicators were field tested in eight hospitals using a cohort of older persons aged 70 years and older. After analysis of the field study data (indicator prevalence, variability across sites), in a second meeting, the advisory panel further defined the PQIs. The advisory panel formally voted for selection of those PQIs that were most appropriate for care evaluation. In addition to seven previously published PQIs relevant to the care of older persons, 15 new indicators were created. These 22 PQIs were then field tested. PQIs designed specifically for the older ED population with cognitive impairment were only scored for patients with identified cognitive impairment. Following formal voting, a total of 11 PQIs were included in the set. These PQIs targeted cognitive screening, delirium screening, delirium risk assessment, evaluation of acute change in mental status, delirium etiology, proxy notification, collateral history, involvement of a nominated support person, pain assessment, postdischarge follow-up, and ED length of stay. This article presents a set of PQIs for the evaluation of the care for older people with cognitive impairment in EDs. The variation in indicator

  5. Perturbed Energy Metabolism and Neuronal Circuit Dysfunction in Cognitive Impairment

    PubMed Central

    Kapogiannis, Dimitrios; Mattson, Mark P.

    2010-01-01

    Summary Epidemiological, neuropathological and functional neuroimaging evidence implicates global and regional derangements in brain metabolism and energetics in the pathogenesis of cognitive impairment. Nerve cell microcircuits are modified adaptively by excitatory and inhibitory synaptic activity and neurotrophic factors. Aging and Alzheimer’s disease (AD) cause perturbations in cellular energy metabolism, level of excitation/inhibition and neurotrophic factor release that overwhelm compensatory mechanisms and result in neuronal microcircuit and brain network dysfunction. A prolonged positive energy balance impairs the ability of neurons to respond adaptively to oxidative and metabolic stress. Experimental studies in animals demonstrate how derangements related to chronic positive energy balance, such as diabetes, set the stage for accelerated cognitive aging and AD. Therapeutic interventions to allay cognitive dysfunction that target energy metabolism and adaptive stress responses (such as neurotrophin signaling) have shown efficacy in animal models and preliminary studies in humans. PMID:21147038

  6. Occupational therapy for cognitive impairment in stroke patients.

    PubMed

    Hoffmann, Tammy; Bennett, Sally; Koh, Chia-Lin; McKenna, Kryss T

    2010-09-08

    Cognitive impairment is a frequent consequence of stroke and can impact on a person's ability to perform everyday activities. There are a number of different intervention strategies that occupational therapists may use when working with people who have cognitive impairment post-stroke. To determine whether occupational therapy improves functional performance of basic activities of daily living (ADL) and specific cognitive abilities in people who have cognitive impairment following a stroke. We searched the Cochrane Stroke Group Trials Register (last searched May 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to April 2009), EMBASE (1980 to April 2009), CINAHL (1982 to April 2009), PsycINFO (1840 to April 2009), PsycBITE, OTseeker and Dissertation Abstracts (the latest three were searched up to April 2009). In an effort to identify further published, unpublished, and ongoing trials, we also tracked relevant references through the cited reference search in Science Citation Index (SCI) and Social Science Citation Index (SSCI), reviewed the reference lists of relevant studies and reviews, handsearched relevant occupational therapy journals, and contacted key researchers in the area. Randomised and quasi-randomised controlled trials that evaluated an intervention focused on providing cognitive retraining to adults with clinically defined stroke and confirmed cognitive impairment. The intervention needed either to be provided by an occupational therapist or given under the supervision of an occupational therapist. Two review authors independently examined the abstracts that might meet the inclusion criteria, assessed the quality and extracted data. We have presented results using mean differences. We included one trial with 33 participants in this review. We found no difference between groups for the two relevant outcomes that were measured: improvement in time judgement skills and improvement in

  7. Social cognition according to cognitive impairment in different clinical phenotypes of multiple sclerosis.

    PubMed

    Dulau, Cecile; Deloire, Mathilde; Diaz, Helene; Saubusse, Aurore; Charre-Morin, Julie; Prouteau, Antoinette; Brochet, Bruno

    2017-04-01

    The objective of this study is to evaluate the relationship between social cognition (SC) and cognitive impairment in persons with multiple sclerosis (PwMS). A prospective study was conducted in 60 PwMS, 30 with relapsing-remitting MS (RRMS), 15 with secondary progressive MS (SPMS) and 15 with primary progressive MS (PPMS), and in healthy subjects (HS). All subjects were assessed by the Bordeaux Social Cognition Evaluation Protocol (PECS-B) (facial emotion recognition, theory of mind, emotional awareness and cognitive and affective alexithymia), by a large neuropsychological battery and by questionnaires (depression and anxiety). 43.3% of PwMS were impaired for at least one SC test. The proportion of PwMS with at least two impaired SC tests was similar in all three phenotypes (20%). Mean scores differed significantly between PwMS and HS only for the Reading the Mind in the Eyes Test, a test of Theory of Mind (ToM). ANOVA analyses showed an effect of phenotype on emotional awareness scores with lower scores in PPMS as compared to RRMS. ToM performance was significantly correlated (r (2) = 0.56) with executive functions, working memory and episodic memory scores. SC impairment was found in all phenotypes and was more prominent in cognitively impaired MS patients. Executive functions, and working and episodic memory performance accounts for approximately 50% of ToM performance. Emotional awareness is more impaired in progressive MS.

  8. Patterns of Clinically Significant Cognitive Impairment in Hoarding Disorder

    PubMed Central

    Mackin, R. Scott; Vigil, Ofilio; Insel, Philip; Kivowitz, Alana; Kupferman, Eve; Hough, Christina; Fekri, Shiva; Delucchi, Kevin L.; Mathews, Carol A.

    2017-01-01

    OBJECTIVES The cognitive characteristics of individuals with Hoarding Disorder (HD) are not well understood. Existing studies are relatively few and somewhat inconsistent but suggest that individuals with HD may have specific dysfunction in the cognitive domains of categorization, speed of information processing, and decision-making. However, there have been no studies evaluating the degree to which cognitive dysfunction in these domains reflects clinically significant cognitive impairment (CI). METHODS Participants included 78 individuals who met DSM-V criteria for HD and 70 age- and education-matched controls. Cognitive performance on measures of memory, attention, information processing speed, abstract reasoning, visuospatial processing, decision-making, and categorization ability was evaluated for each participant. Rates of clinical impairment for each measure were compared, as were age and education corrected raw scores for each cognitive test. RESULTS HD participants showed greater incidence of CI on measures of visual memory, visual detection, and visual categorization relative to controls. Raw score comparisons between groups showed similar results with HD participants showing lower raw score performance on each of these measures. In addition, in raw score comparisons HD participants also demonstrated relative strengths compared to control participants on measures of verbal and visual abstract reasoning. CONCLUSIONS These results suggest that HD is associated with a pattern of clinically significant CI in some visually mediated neurocognitive processes including visual memory, visual detection, and visual categorization. Additionally these results suggest HD individuals may also exhibit relative strengths, perhaps compensatory, in abstract reasoning in both verbal and visual domains. PMID:26474146

  9. Medication use patterns among demented, cognitively impaired and cognitively intact community-dwelling elderly people.

    PubMed

    Schmader, K E; Hanlon, J T; Fillenbaum, G G; Huber, M; Pieper, C; Horner, R

    1998-07-01

    To determine whether medication use patterns in community-dwelling elderly people vary with level of cognitive function-dementia, cognitive impairment (but not dementia) and intact cognition. Cross-sectional survey. A five-county area of central North Carolina, USA. 520 members of the Duke Established Populations for Epidemiologic Studies of the Elderly. Medication use in the previous 2 weeks was ascertained during a interview in the patient's home and was coded as to prescription and therapeutic class status. Cognitive status, the primary independent variable, was divided into: (i) dementia (n=100); (ii) cognitive impairment but not dementia (n=117); and (iii) cognitively intact (n=303). The dependent variables were any prescription or over-the-counter (OTC) medication use (vs non-use); number of prescription or OTC medications used; and prescription and OTC use combined within major therapeutic classes. Multivariate analyses controlled for socio-demographic characteristics, health status, functional status and access to health care. The use of any prescription medication was similar in the three groups. The demented were significantly less likely than cognitively impaired people to use any OTC medications (OR=0.65, 95% CI=0.45, 0.93), cardiovascular medications (OR=0.70, 95% CI=0.49, 0.99) and analgesics (OR=0.54, 95% CI=0.39, 0.75). As a combined group, those who were demented and cognitively impaired were less likely than the cognitively intact group to use any OTC medications (OR=0.78, 95% CI 0.65, 0.92). Compared with the cognitively impaired subjects, the demented group took fewer prescription medications (beta coefficient=-0.31, 95% CI=-0.59, -0.03) and similar numbers of OTC medications. Compared with those who were cognitively intact, the combined group of demented and cognitively impaired subjects took fewer OTC medications (beta coefficient=-0.14, 95% CI=-0.23, -0.05) and similar numbers of prescription medications. Increasing level of cognitive

  10. Multiple Spatial Mappings in Numerical Cognition

    ERIC Educational Resources Information Center

    Shaki, Samuel; Fischer, Martin H.

    2012-01-01

    A recent cross-cultural comparison (Shaki, Fischer, & Petrusic, 2009) suggested that spatially consistent processing habits for words and numbers are a necessary condition for the spatial representation of numbers (Spatial-Numerical Association of Response Codes; SNARC effect). Here we reexamine the SNARC in Israelis who read text from right…

  11. The Cognitive and Neural Expression of Semantic Memory Impairment in Mild Cognitive Impairment and Early Alzheimer's Disease

    ERIC Educational Resources Information Center

    Joubert, Sven; Brambati, Simona M.; Ansado, Jennyfer; Barbeau, Emmanuel J.; Felician, Olivier; Didic, Mira; Lacombe, Jacinthe; Goldstein, Rachel; Chayer, Celine; Kergoat, Marie-Jeanne

    2010-01-01

    Semantic deficits in Alzheimer's disease have been widely documented, but little is known about the integrity of semantic memory in the prodromal stage of the illness. The aims of the present study were to: (i) investigate naming abilities and semantic memory in amnestic mild cognitive impairment (aMCI), early Alzheimer's disease (AD) compared to…

  12. White Matter Damage in the Cholinergic System Contributes to Cognitive Impairment in Subcortical Vascular Cognitive Impairment, No Dementia.

    PubMed

    Liu, Qing; Zhu, Zude; Teipel, Stefan J; Yang, Jianwei; Xing, Yi; Tang, Yi; Jia, Jianping

    2017-01-01

    Cholinergic deficiency has been implicated in the pathogenesis of vascular cognitive impairment (VCI), but the extent of involvement and underlying mechanism remain unclear. In this study, targeting the early stage of VCI, we determined regional atrophy within the basal forebrain and deficiency in cholinergic pathways in 25 patients with vascular cognitive impairment no dementia (VCIND) compared to 24 healthy elderly subjects. By applying stereotaxic cytoarchitectonic maps of the nucleus basalis of Meynert (NbM), no significant atrophy was identified in VCIND. Using probabilistic tractography analysis, our study tracked the two major white matter tracks which map to cholinergic pathways. We identified significantly lower fractional anisotropy (FA) in VCIND. Mediation analysis demonstrated that FA in the tracked pathways could fully account for the executive dysfunction, and partly mediate the memory and global cognition impairment. Our study suggests that the fibers mapped to the cholinergic pathways, but not the NbM, are significantly impaired in VCIND. MRI-based in vivo tracking of cholinergic pathways together with NbM measurement may become a valuable in vivo marker for evaluating the cholinergic system in cognitive disorders.

  13. The Cognitive and Neural Expression of Semantic Memory Impairment in Mild Cognitive Impairment and Early Alzheimer's Disease

    ERIC Educational Resources Information Center

    Joubert, Sven; Brambati, Simona M.; Ansado, Jennyfer; Barbeau, Emmanuel J.; Felician, Olivier; Didic, Mira; Lacombe, Jacinthe; Goldstein, Rachel; Chayer, Celine; Kergoat, Marie-Jeanne

    2010-01-01

    Semantic deficits in Alzheimer's disease have been widely documented, but little is known about the integrity of semantic memory in the prodromal stage of the illness. The aims of the present study were to: (i) investigate naming abilities and semantic memory in amnestic mild cognitive impairment (aMCI), early Alzheimer's disease (AD) compared to…

  14. White Matter Damage in the Cholinergic System Contributes to Cognitive Impairment in Subcortical Vascular Cognitive Impairment, No Dementia

    PubMed Central

    Liu, Qing; Zhu, Zude; Teipel, Stefan J.; Yang, Jianwei; Xing, Yi; Tang, Yi; Jia, Jianping

    2017-01-01

    Cholinergic deficiency has been implicated in the pathogenesis of vascular cognitive impairment (VCI), but the extent of involvement and underlying mechanism remain unclear. In this study, targeting the early stage of VCI, we determined regional atrophy within the basal forebrain and deficiency in cholinergic pathways in 25 patients with vascular cognitive impairment no dementia (VCIND) compared to 24 healthy elderly subjects. By applying stereotaxic cytoarchitectonic maps of the nucleus basalis of Meynert (NbM), no significant atrophy was identified in VCIND. Using probabilistic tractography analysis, our study tracked the two major white matter tracks which map to cholinergic pathways. We identified significantly lower fractional anisotropy (FA) in VCIND. Mediation analysis demonstrated that FA in the tracked pathways could fully account for the executive dysfunction, and partly mediate the memory and global cognition impairment. Our study suggests that the fibers mapped to the cholinergic pathways, but not the NbM, are significantly impaired in VCIND. MRI-based in vivo tracking of cholinergic pathways together with NbM measurement may become a valuable in vivo marker for evaluating the cholinergic system in cognitive disorders. PMID:28289381

  15. White matter damage and cognitive impairment after traumatic brain injury

    PubMed Central

    Greenwood, Richard; Powell, Jane Hilary; Leech, Robert; Hawkins, Peter Charlie; Bonnelle, Valerie; Patel, Maneesh Chandrakant; Counsell, Serena Jane; Sharp, David James

    2011-01-01

    White matter disruption is an important determinant of cognitive impairment after brain injury, but conventional neuroimaging underestimates its extent. In contrast, diffusion tensor imaging provides a validated and sensitive way of identifying the impact of axonal injury. The relationship between cognitive impairment after traumatic brain injury and white matter damage is likely to be complex. We applied a flexible technique—tract-based spatial statistics—to explore whether damage to specific white matter tracts is associated with particular patterns of cognitive impairment. The commonly affected domains of memory, executive function and information processing speed were investigated in 28 patients in the post-acute/chronic phase following traumatic brain injury and in 26 age-matched controls. Analysis of fractional anisotropy and diffusivity maps revealed widespread differences in white matter integrity between the groups. Patients showed large areas of reduced fractional anisotropy, as well as increased mean and axial diffusivities, compared with controls, despite the small amounts of cortical and white matter damage visible on standard imaging. A stratified analysis based on the presence or absence of microbleeds (a marker of diffuse axonal injury) revealed diffusion tensor imaging to be more sensitive than gradient-echo imaging to white matter damage. The location of white matter abnormality predicted cognitive function to some extent. The structure of the fornices was correlated with associative learning and memory across both patient and control groups, whilst the structure of frontal lobe connections showed relationships with executive function that differed in the two groups. These results highlight the complexity of the relationships between white matter structure and cognition. Although widespread and, sometimes, chronic abnormalities of white matter are identifiable following traumatic brain injury, the impact of these changes on cognitive function

  16. Persistent infection with neurotropic herpes viruses and cognitive impairment.

    PubMed

    Watson, A M M; Prasad, K M; Klei, L; Wood, J A; Yolken, R H; Gur, R C; Bradford, L D; Calkins, M E; Richard, J; Edwards, N; Savage, R M; Allen, T B; Kwentus, J; McEvoy, J P; Santos, A B; Wiener, H W; Go, R C P; Perry, R T; Nasrallah, H A; Gur, R E; Devlin, B; Nimgaonkar, V L

    2013-05-01

    Herpes virus infections can cause cognitive impairment during and after acute encephalitis. Although chronic, latent/persistent infection is considered to be relatively benign, some studies have documented cognitive impairment in exposed persons that is untraceable to encephalitis. These studies were conducted among schizophrenia (SZ) patients or older community dwellers, among whom it is difficult to control for the effects of co-morbid illness and medications. To determine whether the associations can be generalized to other groups, we examined a large sample of younger control individuals, SZ patients and their non-psychotic relatives (n=1852). Method Using multivariate models, cognitive performance was evaluated in relation to exposures to herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2) and cytomegalovirus (CMV), controlling for familial and diagnostic status and sociodemographic variables, including occupation and educational status. Composite cognitive measures were derived from nine cognitive domains using principal components of heritability (PCH). Exposure was indexed by antibodies to viral antigens. PCH1, the most heritable component of cognitive performance, declines with exposure to CMV or HSV-1 regardless of case/relative/control group status (p = 1.09 × 10-5 and 0.01 respectively), with stronger association with exposure to multiple herpes viruses (β = -0.25, p = 7.28 × 10-10). There were no significant interactions between exposure and group status. Latent/persistent herpes virus infections can be associated with cognitive impairments regardless of other health status.

  17. Aerobic exercise effects upon cognition in Mild Cognitive Impairment: A systematic review of randomized controlled trials.

    PubMed

    Cammisuli, D M; Innocenti, A; Franzoni, F; Pruneti, C

    2017-07-01

    Several studies have shown that physical activity has positive effects on cognition in healthy older adults without cognitive complains but lesser is known about the effectiveness of aerobic exercise in patients suffering from Mild Cognitive Impairment (MCI). The aim of the present study was to systematically review the evidence from randomized controlled trials (RCTs) about the effects of aerobic exercise upon cognition in MCI patients. To this end, PubMed, Cochrane and Web of Science databases were analytically searched for RCTs including aerobic exercise interventions for MCI patients. There is evidence that aerobic exercise improves cognition in MCI patients. Overall research reported moderate effects for global cognition, logical memory, inhibitory control and divided attention. Due to methodological limitations of the investigated studies, findings should be interpreted with caution. Standardized training protocols, larger scale interventions and follow-ups may also provide better insight into the preventive effects of aerobic exercise on cognitive deterioration in MCI and its conversion into dementia.

  18. Pumps, Aqueducts, and Drought Management: vascular physiology in vascular cognitive impairment

    PubMed Central

    Marshall, Randolph S; Lazar, Ronald M

    2010-01-01

    Vascular cognitive impairment has been traditionally defined by structural pathology – an accumulation of infarcts -- leading to progressive cognitive decline. Recent evidence, however, suggests that cognitive impairment may be independently mediated by hemodynamic dysfunction including global and hemispheral hypoperfusion and altered cerebral blood flow regulation. In this review we examine evidence for the contribution of hemodynamic impairment to cognitive dysfunction in the setting of large vessel disease, cardiac failure, and microvascular disease. If there is a hemodynamic component of vascular cognitive impairment, then treatments proposed to correct impaired vascular physiology may reasonably be expected to treat the cognitive dysfunction as well. PMID:21148438

  19. Cerebellum, Language, and Cognition in Autism and Specific Language Impairment

    PubMed Central

    Hodge, Steven M.; Makris, Nikos; Kennedy, David N.; Caviness, Verne S.; Howard, James; McGrath, Lauren; Steele, Shelly; Frazier, Jean A.; Tager-Flusberg, Helen; Harris, Gordon J.

    2013-01-01

    We performed cerebellum segmentation and parcellation on magnetic resonance images from right-handed boys, aged 6–13 years, including 22 boys with autism (16 with language impairment (ALI)), 9 boys with Specific Language Impairment (SLI), and 11 normal controls. Language-impaired groups had reversed asymmetry relative to unimpaired groups in posterior-lateral cerebellar lobule VIIIA (right side larger in unimpaired groups, left side larger in ALI and SLI), contralateral to previous findings in inferior frontal cortex language areas. Lobule VIIA Crus I was smaller in SLI than in ALI. Vermis volume, particularly anterior I-V, was decreased in language-impaired groups. Language performance test scores correlated with lobule VIIIA asymmetry and with anterior vermis volume. These findings suggest ALI and SLI subjects show abnormalities in neurodevelopment of fronto-corticocerebellar circuits that manage motor control and the processing of language, cognition, working memory, and attention. PMID:19924522

  20. Cognitive Impairment and Persistent CNS Injury in Treated HIV.

    PubMed

    Chan, Phillip; Hellmuth, Joanna; Spudich, Serena; Valcour, Victor

    2016-08-01

    The implementation of combination antiretroviral therapy (cART) has changed HIV infection into a chronic illness, conveying extensive benefits, including greater longevity and advantages for the central nervous system (CNS). However, studies increasingly confirm that the CNS gains are incomplete, with reports of persistent immune activation affecting the CNS despite suppression of plasma HIV RNA. The rate of cognitive impairment is unchanged, although severity is generally milder than in the pre-cART era. In this review, we discuss cognitive outcomes from recently published clinical HIV studies, review observations on HIV biomarkers for cognitive change, and emphasize longitudinal imaging findings. Additionally, we summarize recent studies on CNS viral invasion, CD8 encephalitis, and how CNS involvement during the earliest stages of infection may set the stage for later cognitive manifestations.

  1. High body mass index is associated with impaired cognitive control.

    PubMed

    Sellaro, Roberta; Colzato, Lorenza S

    2017-06-01

    The prevalence of weight problems is increasing worldwide. There is growing evidence that high body mass index (BMI) is associated with frontal lobe dysfunction and cognitive deficits concerning mental flexibility and inhibitory control efficiency. The present study aims at replicating and extending these observations. We compared cognitive control performance of normal weight (BMI < 25) and overweight (BMI ≥ 25) university students on a task tapping either inhibitory control (Experiment 1) or interference control (Experiment 2). Experiment 1 replicated previous findings that found less efficient inhibitory control in overweight individuals. Experiment 2 complemented these findings by showing that cognitive control impairments associated with high BMI also extend to the ability to resolve stimulus-induced response conflict and to engage in conflict-driven control adaptation. The present results are consistent with and extend previous literature showing that high BMI in young, otherwise healthy individuals is associated with less efficient cognitive control functioning.

  2. Nonlinguistic cognitive treatment for bilingual children with primary language impairment

    PubMed Central

    EBERT, KERRY DANAHY; RENTMEESTER-DISHER, JILL; KOHNERT, KATHRYN

    2014-01-01

    Substantial evidence points to the presence of subtle weaknesses in the nonlinguistic cognitive processing skills of children with primary (or specific) language impairment (PLI). It is possible that these weaknesses contribute to the language learning difficulties that characterize PLI, and that treating them can improve language skills. To test this premise, we treated two nonlinguistic cognitive processing skills, processing speed and sustained selective attention, in two Spanish–English bilingual children with PLI. The study followed a single-subject multiple baseline design, with both repeated measures and standardized pre- and post-testing as outcome measures. Results from the repeated measures tasks showed that both participants made gains in nonlinguistic cognitive processing skills as well as in Spanish and English. These results both replicate and extend prior work showing that non-linguistic cognitive processing treatment can positively affect language skills in children with PLI. PMID:22540358

  3. New strategies for Alzheimer's disease and cognitive impairment.

    PubMed

    Maiese, Kenneth; Chong, Zhao Zhong; Hou, Jinling; Shang, Yan Chen

    2009-01-01

    Approximately five million people suffer with Alzheimer's disease (AD) and more than twenty-four million people are diagnosed with AD, pre-senile dementia, and other disorders of cognitive loss worldwide. Furthermore, the annual cost per patient with AD can approach $200,000 with an annual population aggregate cost of $100 billion. Yet, complete therapeutic prevention or reversal of neurovascular injury during AD and cognitive loss is not achievable despite the current understanding of the cellular pathways that modulate nervous system injury during these disorders. As a result, identification of novel therapeutic targets for the treatment of neurovascular injury would be extremely beneficial to reduce or eliminate disability from diseases that lead to cognitive loss or impairment. Here we describe the capacity of intrinsic cellular mechanisms for the novel pathways of erythropoietin and forkhead transcription factors that may offer not only new strategies for disorders such as AD and cognitive loss, but also function as biomarkers for disease onset and progression.

  4. Polysomnographic and Subjective Sleep Markers of Mild Cognitive Impairment

    PubMed Central

    Hita-Yañez, Eva; Atienza, Mercedes; Cantero, Jose L.

    2013-01-01

    Study Objectives: Growing evidence suggests that sleep disturbances precede by years the clinical onset of Alzheimer disease (AD). The goal of the current study is to determine whether changes in polysomnographic (PSG) sleep patterns accompany subjective sleep complaints in patients with mild cognitive impairment (MCI). We further examine whether meaningful changes in objective sleep physiology are predicted by self-reported sleep measures in MCI patients, and whether incipient neurodegeneration contributes to exacerbate sleep misperception. Design, Setting, and Participants: Overnight PSG recordings and self-reported sleep measures were obtained from 25 healthy elderly (HE) subjects and 25 patients with MCI at the sleep laboratory. Results: Both PSG and self-reported sleep measures confirmed that sleep is altered in patients with MCI. Whereas subjective sleep responses predicted fragmentation of slow wave sleep (SWS) in HE individuals, this relationship was not evident in MCI patients. Furthermore, patients with MCI showed significant discrepancies in the estimation of sleep onset latency when compared with HE subjects. Conclusions: Sleep is significantly impaired in patients with mild cognitive impairment at both the objective and subjective level, which may be used as a surrogate marker of preclinical Alzheimer disease. Taken together, these findings aid in the development of novel therapeutic strategies devoted to improve sleep in the elderly population at risk of developing Alzheimer disease. Citation: Hita-Yañez E; Atienza M; Cantero JL. Polysomnographic and subjective sleep markers of mild cognitive impairment. SLEEP 2013;36(9):1327-1334. PMID:23997365

  5. Cognitive impairment and magnetic resonance imaging correlations in Wilson's disease.

    PubMed

    Frota, N A F; Barbosa, E R; Porto, C S; Lucato, L T; Ono, C R; Buchpiguel, C A; Caramelli, P

    2013-06-01

    To evaluate the cognitive performance of a group of patients with Wilson's disease (WD) and to correlate the cognitive findings with changes in magnetic resonance imaging (MRI). All patients with WD consecutively attended in a Movement Disorders Clinic between September 2006 and October 2007 were invited to participate in the study, together with a group of matched healthy controls. Patients and controls were submitted to comprehensive neuropsychological assessment. MRI was performed in all patients, and abnormalities (high-intensity signal, low-intensity signal and atrophy) were semi-quantitatively rated. Performance of patients and controls in each cognitive test was compared, and correlations between cognitive scores and MRI changes were investigated within the patients' group. Twenty patients with WD (11 men) and 20 controls (nine men) were evaluated. Mean age in the WD and control groups was 30.05 ± 7.25 and 32.15 ± 5.37 years, respectively. Mean schooling years were 11.15 ± 3.73 among WD cases and 10.08 ± 2.62 among controls. Patients with WD performed significantly worse than controls in the Mini-Mental State Examination, Dementia Rating Scale, phonemic verbal fluency (FAS), verb generation, digit span forward, Stroop test, Frontal Assessment Battery and in the Brief Cognitive Screening Battery. A significant correlation emerged between global cognitive impairment and MRI scale (r = 0.535), being higher for high-intensity signal plus atrophy (r = 0.718). Patients with WD presented cognitive impairment, especially in executive functions, with good correlation between cognitive abnormalities and MRI changes. © 2012 John Wiley & Sons A/S.

  6. Mild cognitive impairment: disparity of incidence and prevalence estimates.

    PubMed

    Ward, Alex; Arrighi, H Michael; Michels, Shannon; Cedarbaum, Jesse M

    2012-01-01

    The purpose of conducting this study was to identify areas of concordance and sources of variation for the published rates of prevalence and incidence associated with various definitions for mild cognitive impairment (MCI). The study used systematic review of studies published in English since 1984. Studies were identified by searching MEDLINE and EMBASE databases. Population-based observational studies of incidence or prevalence of MCI and related terms were eligible for inclusion. A total of 3,705 citations were identified, and 42 were accepted for inclusion; 35 included data on prevalence and 13 on incidence. The following four terms predominated: age-associated memory impairment (AAMI); cognitive impairment no dementia (CIND); MCI; and amnestic MCI (aMCI). Within each term, the operational definition varied. Substantial variation was observed for both incidence (MCI: 21.5-71.3; aMCI: 8.5-25.9 per 1,000 person-years) and prevalence of each definition of cognitive impairment (AAMI 3.6%-38.4%; CIND 5.1%-35.9%; MCI 3%-42%; aMCI 0.5%-31.9%). CIND and MCI showed increasing prevalence among older age groups, whereas age-specific rates of aMCI were lower and without any apparent age relationship. Prevalence and incidence estimates associated with MCI vary greatly both between definitions and within a definition across the 42 publications. These wide differences pose a significant challenge to our understanding of the social burden of this disease. Enhancement and standardization of operational definitions of the subtypes of cognitive impairment could improve estimates of disease burden and provide a mechanism to assist in the identification of individuals at risk for future Alzheimer's disease and other dementias. Copyright © 2012 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  7. Cognitive impairment in school-aged children with early trauma.

    PubMed

    Bücker, Joana; Kapczinski, Flavio; Post, Robert; Ceresér, Keila M; Szobot, Claudia; Yatham, Lakshmi N; Kapczinski, Natalia S; Kauer-Sant'Anna, Márcia

    2012-08-01

    Exposure to traumatic events during childhood is often associated with the development of psychiatric disorders, cognitive impairment, and poor functioning in adulthood. However, few studies have examined cognitive function, including executive function, memory, and attention, in school-aged children with early trauma compared with age- and sex-matched controls. We recruited 30 medication-naive children between 5 and 12 years of age with a history of early severe trauma from a foster care home, along with 30 age- and sex-matched controls. Psychiatric diagnoses were based on Kiddie Schedule for Affective Disorders and Schizophrenia Epidemiologic Version (K-SADS-E) for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and were confirmed with a clinical interview. The neuropsychologic battery was tailored to assess broad cognitive domains such as learning/working memory, executive function, attention, verbal/premorbid intellectual functioning, and impulsivity. There was a higher prevalence of subsyndromal symptoms in children with a history of childhood trauma, although they rarely met all of the diagnostic criteria for a disorder. Moreover, lower estimated intellectual functioning scores were associated with subsyndromal symptoms in children with a history of trauma, and they performed more poorly on the Digits Span Test of the Wechsler Intelligence Scale for Children-III Edition, suggesting attention impairment. There is a high prevalence of subsyndromal symptoms in school-aged children with trauma and an attention impairment, which may contribute to a cumulative deficit early in cognitive development. These findings further support the need for early interventions that can prevent cognitive impairment when childhood trauma occurs. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Quantification of five neuropsychological approaches to defining mild cognitive impairment

    PubMed Central

    Jak, Amy J.; Bondi, Mark W.; Delano-Wood, Lisa; Wierenga, Christina; Corey-Bloom, Jody; Salmon, David P.; Delis, Dean C.

    2009-01-01

    Objectives Operational definitions of cognitive impairment have varied widely in diagnosing mild cognitive impairment (MCI). Identifying clinical subtypes of MCI has further challenged diagnostic approaches, since varying the components of the objective cognitive assessment can significantly impact diagnosis. Therefore, we investigated the applicability of diagnostic criteria for clinical subtypes of MCI in a naturalistic research sample of community elders and quantified the variability in diagnostic outcomes that results from modifying the neuropsychological definition of objective cognitive impairment. Design Cross-sectional and longitudinal study Setting San Diego, CA, Veterans Administration Hospital Participants 90 nondemented, neurologically normal, community-dwelling older adults were initially assessed and 73 were seen for follow-up approximately 17 months later. Measurements Participants were classified via consensus diagnosis as either normally aging or having MCI via each of five diagnostic strategies, which varied the cutoff for objective impairment as well as the number of neuropsychological tests considered in the diagnostic process. Results A range of differences in the percentages identified as MCI versus cognitively normal were demonstrated, depending on the classification criteria employed. A substantial minority of individuals demonstrated diagnostic instability over time as well as across diagnostic approaches. The single domain non-amnestic subtype diagnosis was particularly unstable (e.g., prone to reclassification as normal at follow up). Conclusion Our findings provide empirical support for a neuropsychologically derived operational definition of clinical subtypes of MCI and point to the importance of using comprehensive neuropsychological assessments. Diagnoses, particularly involving non-amnestic MCI, were variable over time. The applicability and utility of this particular MCI subtype warrants further investigation. PMID:19390294

  9. Cognitive Impairment in Bipolar Disorder and Schizophrenia: A Systematic Review

    PubMed Central

    Vöhringer, Paul A.; Barroilhet, Sergio A.; Amerio, Andrea; Reale, Maria Laura; Alvear, Katherine; Vergne, Derick; Ghaemi, S. Nassir

    2013-01-01

    Aims: Previous comparisons of cognitive decline among patients with bipolar disorder (BD) and schizophrenia (SZ) have found somehow quite similar profiles of deficits, but results have varied between studies. Therefore an extensive and thoughtful systematic review of the matter is warranted. Methods: Studies were found through systematic search (PubMed) following PRISMA guidelines. To be included, studies must have assessed the following cognitive functions: executive functions, memory, IQ, attention-concentration, and perceptuomotor function. In order to make comparison between the two entities, studies should include BD patients with operationally defined euthymia, schizophrenic patients in remission, and third group of healthy control patients. Comparisons were made after controlling for years of schooling and residual affective symptoms. Results: We found that overall both SZ and BD patients present deficits on all neurocognitive measures compared to healthy controls. In particular, SZ patients show more severe and pervasive cognitive deficits while BD patients present a milder and more confined impairment. In addition, evidence from the literature suggests that SZ and BD patients share a similar cognitive impairment profile with different degrees of deficits. Therefore, the difference between the two groups seems to be more quantitative (degree of deficit) rather than qualitative (profile), supporting a dimensional approach to the two clinical entities. Limitations of the present review includes the impossibility to control for effects of medication, varying time required for assessment across studies, illness diagnosis reliability, and course severity. Conclusion: Patients with BD might exhibit a cognitive impairment that could be similar to SZ in terms of their profile, although patients with SZ may have more severe and widespread impairments. PMID:23964248

  10. Pain intensity assessment: a comparison of selected pain intensity scales for use in cognitively intact and cognitively impaired African American older adults.

    PubMed

    Taylor, Laurie Jowers; Herr, Keela

    2003-06-01

    The purpose of this study was to determine the reliability and validity of selected pain intensity scales including the Faces Pain Scale (FPS), the Verbal Description Scale, the Numeric Rating Scale, and the Iowa Pain Thermometer to assess pain in cognitively impaired minority older adults. A descriptive correlational design was used, and a convenience sample of 57 volunteers age 58 and older residing in the South was recruited for this study. The sample consisted of 8 males and 49 females with a mean age of 76. Fifty-nine percent of the sample completed an 11th grade education or less, and 59% completed high school or college. Seventy-seven percent (n = 44) of the sample scored 24 or less on the mental status exam, indicating some degree of cognitive impairment. The remaining 23% (n = 13) were cognitively intact. All of the participants were able to use each of the scales to rate their pain. Concurrent validity of the scales was supported with Spearman rank correlation coefficients ranging from.74 to.83 in the cognitively impaired group and.81 to.96 in the cognitively intact group. Test-retest reliability at a 2-week interval was acceptable in the cognitively intact group (Spearman rank correlations ranged from.73 to.83) and to a lesser degree in the cognitively impaired group (correlations ranged from.52 to.79). When asked about scale preference, both the cognitively impaired and the intact group indicated a preference for the FPS. Findings from this study suggest that cognitive impairment did not inhibit older minority participants' ability to use a variety of pain intensity scales. Additionally, options should be provided that address individual needs of older adults considering specific cognitive level and disability, education, gender, ethnicity, and cultural influences concerning perceptions of the various pain intensity scales.

  11. Cognitive variability in bipolar II disorder: who is cognitively impaired and who is preserved.

    PubMed

    Solé, Brisa; Jiménez, Esther; Torrent, Carla; Del Mar Bonnin, Caterina; Torres, Imma; Reinares, María; Priego, Ángel; Salamero, Manel; Colom, Francesc; Varo, Cristina; Vieta, Eduard; Martínez-Arán, Anabel

    2016-05-01

    Although it is well established that euthymic patients with bipolar disorder can have cognitive impairment, substantial heterogeneity exists and little is known about the extent and severity of impairment within the bipolar II disorder subtype. Therefore, the main aim of this study was to analyze cognitive variability in a sample of patients with bipolar II disorder. The neuropsychological performance of 116 subjects, including 64 euthymic patients with bipolar II disorder and 52 healthy control subjects, was examined and compared by means of a comprehensive neurocognitive battery. Neurocognitive data were analyzed using a cluster analysis to examine whether there were specific groups based on neurocognitive patterns. Subsequently, subjects from each cluster were compared on demographic, clinical, and functional variables. A three-cluster solution was identified with an intact neurocognitive group (n = 29, 48.3%), an intermediate or selectively impaired group (n = 24, 40.0%), and a globally impaired group (n = 7, 11.6%). Among the three clusters, statistically significant differences were observed in premorbid intelligence quotient (p = 0.002), global functional outcome (p = 0.021), and leisure activities (p = 0.001), with patients in the globally impaired cluster showing the lowest attainments. No differences in other clinical characteristics were found among the groups. These results confirm that neurocognitive variability is also present among patients with bipolar II disorder. Approximately one-half of the patients with bipolar II disorder were cognitively impaired, and among them 12% were severely and globally impaired. The identification of different cognitive profiles may help to develop cognitive remediation programs specifically tailored for each cognitive profile. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Statins Decrease Neuroinflammation and Prevent Cognitive Impairment after Cerebral Malaria

    PubMed Central

    Reis, Patricia A.; Estato, Vanessa; da Silva, Tathiany I.; d'Avila, Joana C.; Siqueira, Luciana D.; Assis, Edson F.; Bozza, Patricia T.; Bozza, Fernando A.; Tibiriça, Eduardo V.; Zimmerman, Guy A.; Castro-Faria-Neto, Hugo C.

    2012-01-01

    Cerebral malaria (CM) is the most severe manifestation of Plasmodium falciparum infection in children and non-immune adults. Previous work has documented a persistent cognitive impairment in children who survive an episode of CM that is mimicked in animal models of the disease. Potential therapeutic interventions for this complication have not been investigated, and are urgently needed. HMG-CoA reductase inhibitors (statins) are widely prescribed for cardiovascular diseases. In addition to their effects on the inhibition of cholesterol synthesis, statins have pleiotropic immunomodulatory activities. Here we tested if statins would prevent cognitive impairment in a murine model of cerebral malaria. Six days after infection with Plasmodium berghei ANKA (PbA) mice displayed clear signs of CM and were treated with chloroquine, or chloroquine and lovastatin. Intravital examination of pial vessels of infected animals demonstrated a decrease in functional capillary density and an increase in rolling and adhesion of leukocytes to inflamed endothelium that were reversed by treatment with lovastatin. In addition, oedema, ICAM-1, and CD11b mRNA levels were reduced in lovastatin-treated PbA-infected mice brains. Moreover, HMOX-1 mRNA levels are enhanced in lovastatin-treated healthy and infected brains. Oxidative stress and key inflammatory chemokines and cytokines were reduced to non-infected control levels in animals treated with lovastatin. Fifteen days post-infection cognitive dysfunction was detected by a battery of cognition tests in animals rescued from CM by chloroquine treatment. In contrast, it was absent in animals treated with lovastatin and chloroquine. The outcome was similar in experimental bacterial sepsis, suggesting that statins have neuroprotective effects in severe infectious syndromes in addition to CM. Statin treatment prevents neuroinflammation and blood brain barrier dysfunction in experimental CM and related conditions that are associated with

  13. Personality traits and risk of cognitive impairment and dementia.

    PubMed

    Terracciano, Antonio; Stephan, Yannick; Luchetti, Martina; Albanese, Emiliano; Sutin, Angelina R

    2017-06-01

    We investigated the association between five factor model personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and risk of dementia, cognitive impairment not dementia (CIND), and conversion from CIND to dementia in a large national cohort. Participants from the Health and Retirement Study (N > 10,000) completed a personality scale in 2006-2008 and their cognitive status was tracked for up to 8 years using the modified Telephone Interview for Cognitive Status (TICSm). Adjusting for age, sex, education, race, and ethnicity, lower conscientiousness and agreeableness and higher neuroticism were independently associated with increased risk of dementia. These associations remained significant after adjusting for other risk factors for dementia, including income, wealth, smoking, physical inactivity, obesity, diabetes, hypertension, and blood biomarkers. These associations were not modified by age, sex, race, ethnicity, and education, suggesting that the associations of personality with risk of dementia were similar across demographic groups. Neuroticism and conscientiousness were also associated with risk of CIND. Low conscientiousness predicted conversion from CIND to dementia. Using brief assessments of personality and cognition, we found robust evidence that personality is associated with risk of cognitive impairment and dementia in a large national sample. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Association between cognitive impairment and urinary dysfunction in Parkinson's disease.

    PubMed

    Tkaczynska, Zuzanna; Pilotto, Andrea; Becker, Sara; Gräber-Sultan, Susanne; Berg, Daniela; Liepelt-Scarfone, Inga

    2017-02-17

    Urinary dysfunction (UD) is a common non-motor feature of Parkinson's disease (PD), and might be secondary to neurodegeneration involving cortical and subcortical brain areas. The possible link between UD and cognitive deficits has never been examined in frontal cortex impairment, and is still not completely understood in PD. In the present study, 94 PD patients underwent a comprehensive motor, cognitive and non-motor assessment. It was shown that 55.3% of patients reported UD, of which 17% needed specific urological treatment. Patients who reported UD performed worse on global cognition (PANDA, p = .05), visuo-constructive functions (CERAD/praxis, p = .03; and Figure Test, p = .03), and instrumental activities of daily living functions (IADL, p = .03), than patients without UD. The group with UD medication performed worse on global cognition (PANDA, p = .02) and visuo-constructive functions (CERAD/praxis, p = .05; CERAD/praxis recall, p = .05) than the UD group without medication, independent of anticholinergic treatment effect. Our findings suggest an association between cognitive impairment and UD in PD independent from symptomatic treatment.

  15. Clinical features, comorbidity, and cognitive impairment in elderly bipolar patients

    PubMed Central

    Rise, Ida Vikan; Haro, Josep Maria; Gjervan, Bjørn

    2016-01-01

    Introduction Data specific to late-life bipolar disorder (BD) are limited. Current research is sparse and present guidelines are not adapted to this group of patients. Objectives We present a literature review on clinical characteristics, comorbidities, and cognitive impairment in patients with late-life BD. This review discusses common comorbidities that affect BD elders and how aging might affect cognition and treatment. Methods Eligible studies were identified in MedLine by the Medical Subject Headings terms “bipolar disorder” and “aged”. We only included original research reports published in English between 2012 and 2015. Results From 414 articles extracted, 16 studies were included in the review. Cardiovascular and respiratory conditions, type II diabetes, and endocrinological abnormalities were observed as highly prevalent. BD is associated with a high suicide risk. Bipolar elderly had an increased risk of dementia and performed worse on cognitive screening tests compared to age-matched controls across different levels of cognition. Despite high rates of medical comorbidity among bipolar elderly, a systematic under-recognition and undertreatment of cardiovascular disease have been suggested. Conclusion There was a high burden of physical comorbidities and cognitive impairment in late-life BD. Bipolar elderly might be under-recorded and undertreated in primary medical care, indicating that this group needs an adapted clinical assessment and specific clinical guidelines need to be established. PMID:27274256

  16. Treating cognitive impairment with transcranial low level laser therapy.

    PubMed

    de la Torre, Jack C

    2017-03-01

    This report examines the potential of low level laser therapy (LLLT) to alter brain cell function and neurometabolic pathways using red or near infrared (NIR) wavelengths transcranially for the prevention and treatment of cognitive impairment. Although laser therapy on human tissue has been used for a number of medical conditions since the late 1960s, it is only recently that several clinical studies have shown its value in raising neurometabolic energy levels that can improve cerebral hemodynamics and cognitive abilities in humans. The rationale for this approach, as indicated in this report, is supported by growing evidence that neurodegenerative damage and cognitive impairment during advanced aging is accelerated or triggered by a neuronal energy crisis generated by brain hypoperfusion. We have previously proposed that chronic brain hypoperfusion in the elderly can worsen in the presence of one or more vascular risk factors, including hypertension, cardiac disease, atherosclerosis and diabetes type 2. Although many unanswered questions remain, boosting neurometabolic activity through non-invasive transcranial laser biostimulation of neuronal mitochondria may be a valuable tool in preventing or delaying age-related cognitive decline that can lead to dementia, including its two major subtypes, Alzheimer's and vascular dementia. The technology to achieve significant improvement of cognitive dysfunction using LLLT or variations of this technique is moving fast and may signal a new chapter in the treatment and prevention of neurocognitive disorders. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Immunological processes related to cognitive impairment in MS.

    PubMed

    Berger, T

    2016-09-01

    In this review, the immune-to-brain communication pathways are briefly summarized, with emphasis on the impact of immune cells and their mediators on learning, memory and other cognitive domains. Further, the acute response of the central nervous system to peripherally generated inflammatory stimuli - termed as sickness behaviour - is described, and the central role of microglia in this immune-to-brain crosstalk in physiological and pathological conditions is highlighted. Finally, the role and consequences of immunological processes related to cognitive impairment in multiple sclerosis are discussed. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Movement-in-depth, cognitive impairment, and crash risk.

    PubMed

    Smither, Janan Al-Awar; Gentzler, Marc C; Kennedy, Robert S

    2012-01-01

    In this study, 243 cognitively intact and cognitively impaired older participants' movement-in-depth (looming) abilities were assessed using a portable device that we had previously developed in our laboratory. Results indicated normative relationships between looming ability and age, looming ability and driving violation records, and age and driving violation records. Findings also confirmed the validity and reliability of the measurements taken with the device. In conclusion, this device may be useful for identifying drivers at risk for rear-end collisions, developing effective training interventions, and creating fair and valid driver licensing tests.

  19. Brain rhythms connect impaired inhibition to altered cognition in schizophrenia.

    PubMed

    Pittman-Polletta, Benjamin R; Kocsis, Bernat; Vijayan, Sujith; Whittington, Miles A; Kopell, Nancy J

    2015-06-15

    In recent years, schizophrenia research has focused on inhibitory interneuron dysfunction at the level of neurobiology and on cognitive impairments at the psychological level. Reviewing both experimental and computational findings, we show how the temporal structure of the activity of neuronal populations, exemplified by brain rhythms, can begin to bridge these levels of complexity. Oscillations in neuronal activity tie the pathophysiology of schizophrenia to alterations in local processing and large-scale coordination, and these alterations in turn can lead to the cognitive and perceptual disturbances observed in schizophrenia. Copyright © 2015 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  20. Brain Rhythms Connect Impaired Inhibition to Altered Cognition in Schizophrenia

    PubMed Central

    Pittman-Polletta, Benjamin R.; Kocsis, Bernat; Vijayan, Sujith; Whittington, Miles A.; Kopell, Nancy J.

    2015-01-01

    In recent years, schizophrenia research has focused on inhibitory interneuron dysfunction at the level of neurobiology, and on cognitive impairments at the psychological level. Reviewing both experimental and computational findings, we show how the temporal structure of the activity of neuronal populations, exemplified by brain rhythms, can begin to bridge these levels of complexity. Oscillations in neuronal activity tie the pathophysiology of schizophrenia to alterations in local processing and large-scale coordination, and these alterations in turn can lead to the cognitive and perceptual disturbances observed in schizophrenia. PMID:25850619

  1. Memory training (MT) in mild cognitive impairment (MCI) generates change in cognitive performance.

    PubMed

    Olchik, Maira Rozenfeld; Farina, Jeanette; Steibel, Nicole; Teixeira, Adriane Ribeiro; Yassuda, Mônica Sanches

    2013-01-01

    Longevity can be accompanied by several challenges, among them cognitive decline. The early identification of cognitive impairment offers the opportunity to act with the aim of preventing or delaying dementia. One potential intervention measure is MT. To test the effect of MT in a sample of older individuals previously identified as having MCI. A randomized controlled clinical trial was carried out. Subjects were recruited by the local media for a memory study and were submitted to a battery of cognitive tests. Subjects meeting inclusion criteria (n=112) were classified as normal controls (n=65) and MCI (n=47), according to Gauthier and Touchon's criteria (Gauthier & Touchon, 2005). The study sample was randomly assigned to three different intervention groups: MT group, educational intervention (EI) group, and control group (CG). The MT group received eight training sessions to learn mnemonic strategies based on ecological tasks. They also completed tasks which recruited attention and executive functions. Educational content on memory and aging was also offered. The EI participated in the same number of sessions, yet, only the educational content was offered. The CG completed pre- and post-test evaluations, and received training afterwards. Training effects were modest and for certain variables they were equivalent to retest effects. However, after training, individuals with MCI in the MT group exhibited cognitive performance typical of individuals without cognitive impairment, suggesting cognitive plasticity. MT is a feasible non-pharmacological intervention which might bring positive performance change in older adults facing cognitive impairment. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  2. VISUOSPATIAL AND NUMERICAL COGNITIVE DEFICITS IN CHILDREN WITH CHROMOSOME 22Q11.2 DELETION SYNDROME

    PubMed Central

    Simon, Tony J.; Bearden, Carrie E.; Mc-Ginn, Donna McDonald; Zackai, Elaine

    2015-01-01

    This article presents some of the earliest evidence of visuospatial and numerical cognitive deficits in children with the chromosome 22q11.2 deletion syndrome; a common but ill-understood genetic disorder resulting in medical complications, cognitive impairment, and brain morphologic changes. Relative to a group of typically developing controls, deleted children performed more poorly on tests of visual attentional orienting, visual enumeration and relative numerical magnitude judgment. Results showed that performance deficits in children with the deletion could not be explained by a global deficit in psychomotor speed. Instead, our findings are supportive of the hypothesis that visuospatial and numerical deficits in children with the chromosome 22q11.2 deletion are due, at least in part, to posterior parietal dysfunction. PMID:15714897

  3. Risk factors for pain in children with severe cognitive impairments.

    PubMed

    Breau, Lynn M; Camfield, Carol S; McGrath, Patrick J; Finley, G Allen

    2004-06-01

    Diagnosing cause of pain in children with severe cognitive impairments is difficult due to their problems with communication. Identification of risk factors for specific pain etiologies might help professionals in this task. The aim of this study was to determine whether child-related characteristics increase risk for specific types of pain. Participants were the caregivers of 41 females and 53 males with moderate to profound mental retardation, who were aged 3 to 18 years 8 months (mean 10:1, SD 4:4) but who communicated at the level of a typical child of 13.8 months (SD 10 months): 44 of the children had cerebral palsy (CP) and 59 a seizure disorder. Caregivers reported the cause of children's episodes of pain for four 1-week periods over 1 year. Logistic regression analyses were used to predict occurrence of specific types of pain using children's demographic, medical, and physical characteristics. Children had 406 episodes of pain due to accident, gastrointestinal conditions, musculoskeletal problems, infection, recurrent conditions, and common childhood causes. Results indicated that a unique set of risk factors predicted each pain type in this sample. Significant risk factors for pain included: lack of visual impairment and leg impairment (accidental pain); seizures, leg impairment, and greater number of medications (non-accidental pain); being male and tube fed (musculoskeletal pain); age <7 years, absence of CP, visual impairment, and less frequent medical monitoring (infection pain); being female and with arm impairment (gastrointestinal pain); and being tube fed and taking fewer medications (common childhood pains). In most cases, models were more specific than sensitive, indicating that the significant predictors are more useful for eliminating potential pain causes. These results suggest that population risk factors may be helpful in structuring diagnostic investigations for individual children with severe cognitive impairments.

  4. Long-Term Cognitive Impairment in Kleine-Levin Syndrome

    PubMed Central

    Uguccioni, Ginevra; Lavault, Sophie; Chaumereuil, Charlotte; Golmard, Jean-Louis; Gagnon, Jean-François; Arnulf, Isabelle

    2016-01-01

    Study Objectives: In Kleine-Levin syndrome (KLS), episodes of hypersomnia, cognitive, and behavioral disturbances alternate with asymptomatic periods. Because 50% of patients report decreased academic performances, we evaluated their cognitive status during asymptomatic periods, determinants of deficits, and changes during follow-up. Methods: The cognitive assessment during asymptomatic periods in all consecutive patients with typical KLS and healthy controls included the non-verbal intelligence quotient (Raven Progressive Matrices), the Trail Making Test, the Stroop Color-Word Test, the Wechsler Memory Test, verbal fluencies, the Free and Cued Learning Memory Test, and the Rey-Osterreith Complex Figure. Cognitive status was reevaluated after 0.5 to 2 y in 44 patients. Results: At baseline, compared with the 42 controls, the 122 patients with KLS exhibited lower non-verbal intelligence quotient, speed of processing, attention, and reduced retrieval strategies in episodic memory. Higher episode frequency, shorter episode duration, shorter time since last episode, deeper sleep, and megaphagia during episodes predicted impaired memory. The visuoconstructional abilities and non-verbal memory were intact. After a mean follow-up of 1.7 ± 1.0 y, the episode frequency decreased from 4.6 ± 4.8 to 1.7 ± 1.9/y. The logical reasoning and attention improved, the processing speed remained low, and the retrieval strategies in verbal memory further worsened. Conclusions: In this field study, one-third of patients with KLS have long-term cognitive deficits affecting retrieval and processing speed. Cognitive function should be systematically tested in patients with KLS, which appears important to help patients in their academic studies. Citation: Uguccioni G, Lavault S, Chaumereuil C, Golmard JL, Gagnon JF, Arnulf I. Long-term cognitive impairment in kleine-levin syndrome. SLEEP 2016;39(2):429–438. PMID:26414895

  5. Frequent Amyloid Deposition Without Significant Cognitive Impairment Among the Elderly

    PubMed Central

    Aizenstein, Howard Jay; Nebes, Robert D.; Saxton, Judith A.; Price, Julie C.; Mathis, Chester A.; Tsopelas, Nicholas D.; Ziolko, Scott K.; James, Jeffrey A.; Snitz, Beth E.; Houck, Patricia R.; Bi, Wenzhu; Cohen, Ann D.; Lopresti, Brian J.; DeKosky, Steven T.; Halligan, Edythe M.; Klunk, William E.

    2009-01-01

    Objective To characterize the prevalence of amyloid deposition in a clinically unimpaired elderly population, as assessed by Pittsburgh Compound B (PiB) positron emission tomography (PET) imaging, and its relationship to cognitive function, measured with a battery of neuropsychological tests. Design Subjects underwent cognitive testing and PiB PET imaging (15 mCi for 90 minutes with an ECAT HR + scanner). Logan graphical analysis was applied to estimate regional PiB retention distribution volume, normalized to a cerebellar reference region volume, to yield distribution volume ratios (DVRs). Setting University medical center. Participants From a community-based sample of volunteers, 43 participants aged 65 to 88 years who did not meet diagnostic criteria for Alzheimer disease or mild cognitive impairment were included. Main Outcome Measures Regional PiB retention and cognitive test performance. Results Of 43 clinically unimpaired elderly persons imaged, 9 (21%) showed evidence of early amyloid deposition in at least 1 brain area using an objectively determined DVR cutoff. Demographic characteristics did not differ significantly between amyloid-positive and amyloid-negative participants, and neurocognitive performance was not significantly worse among amyloid-positive compared with amyloid-negative participants. Conclusions Amyloid deposition can be identified among cognitively normal elderly persons during life, and the prevalence of asymptomatic amyloid deposition may be similar to that of symptomatic amyloid deposition. In this group of participants without clinically significant impairment, amyloid deposition was not associated with worse cognitive function, suggesting that an elderly person with a significant amyloid burden can remain cognitively normal. However, this finding is based on relatively small numbers and needs to be replicated in larger cohorts. Longitudinal follow-up of these subjects will be required to support the potential of PiB imaging to

  6. Frequent amyloid deposition without significant cognitive impairment among the elderly.

    PubMed

    Aizenstein, Howard Jay; Nebes, Robert D; Saxton, Judith A; Price, Julie C; Mathis, Chester A; Tsopelas, Nicholas D; Ziolko, Scott K; James, Jeffrey A; Snitz, Beth E; Houck, Patricia R; Bi, Wenzhu; Cohen, Ann D; Lopresti, Brian J; DeKosky, Steven T; Halligan, Edythe M; Klunk, William E

    2008-11-01

    To characterize the prevalence of amyloid deposition in a clinically unimpaired elderly population, as assessed by Pittsburgh Compound B (PiB) positron emission tomography (PET) imaging, and its relationship to cognitive function, measured with a battery of neuropsychological tests. Subjects underwent cognitive testing and PiB PET imaging (15 mCi for 90 minutes with an ECAT HR+ scanner). Logan graphical analysis was applied to estimate regional PiB retention distribution volume, normalized to a cerebellar reference region volume, to yield distribution volume ratios (DVRs). University medical center. From a community-based sample of volunteers, 43 participants aged 65 to 88 years who did not meet diagnostic criteria for Alzheimer disease or mild cognitive impairment were included. Regional PiB retention and cognitive test performance. Of 43 clinically unimpaired elderly persons imaged, 9 (21%) showed evidence of early amyloid deposition in at least 1 brain area using an objectively determined DVR cutoff. Demographic characteristics did not differ significantly between amyloid-positive and amyloid-negative participants, and neurocognitive performance was not significantly worse among amyloid-positive compared with amyloid-negative participants. Amyloid deposition can be identified among cognitively normal elderly persons during life, and the prevalence of asymptomatic amyloid deposition may be similar to that of symptomatic amyloid deposition. In this group of participants without clinically significant impairment, amyloid deposition was not associated with worse cognitive function, suggesting that an elderly person with a significant amyloid burden can remain cognitively normal. However, this finding is based on relatively small numbers and needs to be replicated in larger cohorts. Longitudinal follow-up of these subjects will be required to support the potential of PiB imaging to identify preclinical Alzheimer disease, or, alternatively, to show that amyloid

  7. Cognitive training for impaired neural systems in neuropsychiatric illness.

    PubMed

    Vinogradov, Sophia; Fisher, Melissa; de Villers-Sidani, Etienne

    2012-01-01

    Neuropsychiatric illnesses are associated with dysfunction in distributed prefrontal neural systems that underlie perception, cognition, social interactions, emotion regulation, and motivation. The high degree of learning-dependent plasticity in these networks-combined with the availability of advanced computerized technology-suggests that we should be able to engineer very specific training programs that drive meaningful and enduring improvements in impaired neural systems relevant to neuropsychiatric illness. However, cognitive training approaches for mental and addictive disorders must take into account possible inherent limitations in the underlying brain 'learning machinery' due to pathophysiology, must grapple with the presence of complex overlearned maladaptive patterns of neural functioning, and must find a way to ally with developmental and psychosocial factors that influence response to illness and to treatment. In this review, we briefly examine the current state of knowledge from studies of cognitive remediation in psychiatry and we highlight open questions. We then present a systems neuroscience rationale for successful cognitive training for neuropsychiatric illnesses, one that emphasizes the distributed nature of neural assemblies that support cognitive and affective processing, as well as their plasticity. It is based on the notion that, during successful learning, the brain represents the relevant perceptual and cognitive/affective inputs and action outputs with disproportionately larger and more coordinated populations of neurons that are distributed (and that are interacting) across multiple levels of processing and throughout multiple brain regions. This approach allows us to address limitations found in earlier research and to introduce important principles for the design and evaluation of the next generation of cognitive training for impaired neural systems. We summarize work to date using such neuroscience-informed methods and indicate some

  8. Cognitive Training for Impaired Neural Systems in Neuropsychiatric Illness

    PubMed Central

    Vinogradov, Sophia; Fisher, Melissa; de Villers-Sidani, Etienne

    2012-01-01

    Neuropsychiatric illnesses are associated with dysfunction in distributed prefrontal neural systems that underlie perception, cognition, social interactions, emotion regulation, and motivation. The high degree of learning-dependent plasticity in these networks—combined with the availability of advanced computerized technology—suggests that we should be able to engineer very specific training programs that drive meaningful and enduring improvements in impaired neural systems relevant to neuropsychiatric illness. However, cognitive training approaches for mental and addictive disorders must take into account possible inherent limitations in the underlying brain ‘learning machinery' due to pathophysiology, must grapple with the presence of complex overlearned maladaptive patterns of neural functioning, and must find a way to ally with developmental and psychosocial factors that influence response to illness and to treatment. In this review, we briefly examine the current state of knowledge from studies of cognitive remediation in psychiatry and we highlight open questions. We then present a systems neuroscience rationale for successful cognitive training for neuropsychiatric illnesses, one that emphasizes the distributed nature of neural assemblies that support cognitive and affective processing, as well as their plasticity. It is based on the notion that, during successful learning, the brain represents the relevant perceptual and cognitive/affective inputs and action outputs with disproportionately larger and more coordinated populations of neurons that are distributed (and that are interacting) across multiple levels of processing and throughout multiple brain regions. This approach allows us to address limitations found in earlier research and to introduce important principles for the design and evaluation of the next generation of cognitive training for impaired neural systems. We summarize work to date using such neuroscience-informed methods and indicate

  9. Cognitive and functional changes associated with Aβ pathology and the progression to mild cognitive impairment.

    PubMed

    Insel, Philip S; Donohue, Michael C; Mackin, R Scott; Aisen, Paul S; Hansson, Oskar; Weiner, Michael W; Mattsson, Niklas

    2016-12-01

    Cognitively-normal people with evidence of β-amyloid (Aβ) pathology and subtle cognitive dysfunction are believed to be at high risk for progression to mild cognitive impairment due to Alzheimer's disease (AD). Clinical trials in later stages of AD typically include a coprimary endpoint to demonstrate efficacy on both cognitive and functional assessments. Recent trials focus on cognitively-normal people, but functional decline has not been explored for trial designs in this group. The goal of this study was therefore to characterize cognitive and functional decline in (1) cognitively-normal people converting to mild cognitive impairment (MCI) and (2) cognitively-normal β-amyloid-positive (Aβ+) people. Specifically, we sought to identify and compare the cognitive and functional assessments and their weighted combinations that maximize the longitudinal decline specific to these 2 groups. We studied 68 people who converted from normal cognition to MCI and 70 nonconverters, as well as 137 Aβ+ and 210 β-amyloid-negative cognitively-normal people. We used bootstrap aggregation and cross-validated mixed-models to estimate the distribution of weights applied to cognitive and functional outcomes to form composites. We also evaluated best subset optimization. Using optimized composites, we estimated statistical power for a variety of clinical trial scenarios. Overall, 55.4% of cognitively-normal to MCI converters were Aβ+. Large gains in power estimates were obtained when requiring participants to have both subtle cognitive dysfunction and Aβ pathology compared with requiring Aβ pathology alone. Additional power resulted when including functional as well as cognitive outcomes as part of the composite. Composites formed by applying equal weights to all measures provided the highest estimates of cross-validated power, although similar to both continuous weight optimization and best subset optimization. Using a composite to detect a 30% slowing of decline, 80% power

  10. Physical activity and mild cognitive impairment and Alzheimer's disease.

    PubMed

    Lautenschlager, Nicola T; Cox, Kay; Kurz, Alexander F

    2010-09-01

    Regular physical activity undoubtedly has many health benefits for all age groups. In the past decade, researchers and clinicians have begun to focus their attention on whether physical activity also can improve health outcomes of older adults who experience mild cognitive impairment (MCI) or dementia. This ongoing question is gaining relevance in light of the aging of the world population and with it the rise of age-related conditions, such as cognitive impairment. Not surprisingly, physical activity is among the potential protective lifestyle factors mentioned when strategies to delay or prevent dementia are discussed. The first large-scale multidomain intervention trials are under way to put this to the test. This review aims to give an overview of recent trials of physical activity in patients with MCI or dementia.

  11. [Pain measurement in cognitively impaired patients with the Doloshort scale].

    PubMed

    Likar, R; Pipam, W; Neuwersch, S; Köstenberger, M; Pinter, G; Gatternig, C; Marksteiner, J

    2015-08-01

    Until recently the measurement of pain in cognitively impaired patients represented a neglected field in the diagnostics and treatment of pain. Investigations indicate a prevalence of pain in nursing home residents of between 45 % and 80 %. This study investigated the reliability of the German translation of the Doloshort scale and compared it with the visual analog scale (VS). The aim of this study was to determine the practical applicability of this scale in the clinical routine and to calculate the intrarater reliability (retest) and interrater reliability. The interrater and intrarater reliability of the Doloshort scale was between 0.949 and 0.970. There was a highly significant correlation between the values of the Doloshort scale and the VAS. The Doloshort scale is a well suited measurement instrument for the evaluation of pain in cognitively impaired patients. Because of the short form only simple instructions are necessary and it has a high acceptance with users.

  12. Update on TBI and Cognitive Impairment in Military Veterans.

    PubMed

    Elder, Gregory A

    2015-10-01

    Traumatic brain injury (TBI) is a common cause of morbidity and mortality in military life. Interest in military TBI has increased recently due to the conflicts in Iraq and Afghanistan. Certain types of TBI are relatively unique to the military, the most prominent being blast-related TBI. Blast-related mild TBI has been of particular concern in veterans from the most recent conflicts although controversy remains concerning its separation from post-traumatic stress disorder. TBI is also a risk factor for the later development of neurodegenerative diseases in which cognitive impairment is prominent putting veterans at risk for disorders including Alzheimer's disease and chronic traumatic encephalopathy. Recent evidence associating TBI with chronic cognitive impairment is reviewed in the context of its relevance to military veterans.

  13. Anatomic and clinical pathology of cognitive impairment and dementia.

    PubMed

    Montine, Kathleen S; Montine, Thomas J

    2013-01-01

    Progressive cognitive impairment and its clinical culmination in dementia loom as a major public health problem in the coming generation of older adults, and this fact compels investigation to develop interventions that prevent, delay, or cure. The tools of anatomic pathology have provided key insights into the complex convergence of multiple diseases that commonly contribute to the dementia syndrome and its prodrome in the community setting, and they have suggested some exposures that may modulate disease burden. The tools of clinical pathology, in combination with neuroimaging, have revolutionized the approach to clinical investigation of Alzheimer's disease and are now doing the same with Lewy body disease and vascular brain injury. The tools of anatomic and clinical pathology will continue to contribute to our understanding of these diseases as we advance toward effective interventions for the diseases that commonly cause cognitive impairment and dementia in older adults.

  14. Cognitive Impairment in MS Linked to Structural and Functional Connectivity

    DTIC Science & Technology

    2015-10-01

    mediated inflammation and neurodegeneration within the central nervous system (CNS). Cognitive impairment is estimated to occur in up to 70% of all...neurologic disorder to occur in adults of working-age. Pathologically, MS is characterized by demyelination, immune- mediated inflammation and...sMRI) is sensitive to the neuro -axonal loss and demyelination that occurs in MS 1. A recent meta-analysis of 18 studies of regional grey matter

  15. Cognitive Impairment in MS Linked to Structural and Functional Connectivity

    DTIC Science & Technology

    2016-10-01

    inflammation and neurodegeneration within the central nervous system (CNS). Cognitive impairment is estimated to occur in up to 70% of all patients...disorder to occur in adults of working-age. Pathologically, MS is characterized by demyelination, immune- mediated inflammation and neurodegeneration... neuro -axonal loss and demyelination that occurs in MS 1. A recent meta-analysis of 18 studies of regional grey matter loss in RRMS found that, in

  16. Dementia and Cognitive Impairment: Epidemiology, Diagnosis, and Treatment

    PubMed Central

    Hugo, Julie; Ganguli, Mary

    2014-01-01

    Synopsis Clinicians can diagnose the syndromes of dementia (major neurocognitive disorder) and mild cognitive impairment (mild neurocognitive disorder) based on history, examination, and appropriate objective assessments, using standard criteria such as DSM-5. They can then diagnose the etiological subtypes of these syndromes using standard criteria for each of them. Brain imaging and biomarkers are gaining ground for the differential diagnoses among the different disorders. Treatments for the most part are still symptomatic. PMID:25037289

  17. Mild Cognitive Impairment, Neurodegeneration, and Personalized Lifestyle Medicine

    PubMed Central

    Bland, Jeffrey

    2016-01-01

    The takeaway message of this advancing science surrounding the causes and treatment of neurodegenerative diseases is to recognize MCI symptoms early and intervene with a comprehensive, multifaceted, personalized lifestyle medicine program that is designed to improve neurological function and built on the components described above. The present evidence suggests this approach represents the best medicine available today for beating back the rising tide of cognitive impairment and neurodegeneration. PMID:27330484

  18. Hand movements reflect competitive processing in numerical cognition.

    PubMed

    Faulkenberry, Thomas J

    2014-09-01

    Traditional models of numerical cognition are based on the computer-based metaphor of cognition that assumes numerical judgments are stage-based and independent of bodily effectors. However, recent studies have indicated that the traditional metaphor may be inadequate for describing the processes involved in numerical decisions. In the present study, I provide further evidence that number processing proceeds in a continuous, competitive manner tightly coupled with feedback from the motor system. Forty-five adult participants' hand movements were recorded as they used a computer mouse to choose the correct parity (odd/even) for single-digit numerals. Distributional analyses of these hand movements indicated that responses resulted from competition between parallel and partially active mental representations rather than occurring in discrete stages.

  19. Cognitive Impairment in Individuals with Insomnia: Clinical Significance and Correlates

    PubMed Central

    Fortier-Brochu, Émilie; Morin, Charles M.

    2014-01-01

    Study Objectives: The aims of this study were to (1) investigate the nature of cognitive impairment in individuals with insomnia, (2) document their clinical significance, (3) examine their correlates, and (4) explore differences among individuals with insomnia with and without cognitive complaints. Design: Participants underwent 3 consecutive nights of polysomnography. On the morning following the third night, they completed a battery of questionnaires and neuropsychological tests. Participants: The sample included 25 adults with primary insomnia (mean age: 44.4 ± 11.5 y, 56% women) and 16 controls (mean age: 42.8 ± 12.9 y, 50% women) matched for sex, age, and education. Intervention: N/A. Measurement and Results: Participants completed neuropsychological tests covering attention, memory, working memory, and executive functions, as well as questionnaires assessing the subjective perception of performance, depression, anxiety, fatigue, sleepiness, and hyperarousal. There were significant group differences for the attention and episodic memory domains. Clinically significant deficits were more frequent in the insomnia group. Within the insomnia group, individuals with cognitive complaints exhibited significantly poorer performance on a larger number of neuropsychological variables. All impaired aspects of performance were significantly associated with either subjective or objective sleep continuity, and some were also independently related to sleep microstructure (i.e., relative power for alpha frequencies) or selected psychological variables (i.e., beliefs or arousal). Conclusions: These findings suggest clinically significant alterations in attention and episodic memory in individuals with insomnia. Objective deficits were more pronounced and involved more aspects of performance in a subgroup of individuals with cognitive complaints. These deficits appear associated with sleep continuity, and may also be related to sleep microstructure and dysfunctional beliefs

  20. Tooth loss, chewing efficiency and cognitive impairment in geriatric patients.

    PubMed

    Elsig, Fanny; Schimmel, Martin; Duvernay, Elena; Giannelli, Sandra V; Graf, Christoph E; Carlier, Sabrina; Herrmann, François R; Michel, Jean-Pierre; Gold, Gabriel; Zekry, Dina; Müller, Frauke

    2015-06-01

    Patients with dementia have poorer oral health and fewer teeth than their peers without cognitive impairment. The hypothesis of this study is that the number of natural teeth and the chewing efficiency are associated with cognitive functioning. This cross-sectional study included 29 patients diagnosed with dementia aged 75 years or older and 22 controls who were either cognitively normal (n = 19) or with mild cognitive impairment (n = 3). Neuropsychological, nutritional and dental assessments were performed. The chewing efficiency was evaluated with a two-colour mixing test. Demented patients and controls presented with a mean of 4.9 and 6.5 teeth, respectively (n.s.). The number of natural teeth was not associated with dementia (p = 0.553). Same results were found for age (p = 0.746) and sex (p = 0.901). The chewing efficiency by visual inspection proved worse in participants with dementia than in the controls (p < 0.011) and explained 9.3% of the variance in the diagnosis of dementia. Neither dental state nor chewing efficiency was related to the nutritional state. Chewing efficiency seems stronger associated with cognitive impairment than the number of teeth. Hence, in a more holistic approach for the geriatric assessment, the dental examination may be complemented by a chewing efficiency test. © 2013 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.

  1. Paradoxical upregulation of glutamatergic presynaptic boutons during mild cognitive impairment.

    PubMed

    Bell, Karen F S; Bennett, David A; Cuello, A Claudio

    2007-10-03

    Synaptic integrity is now recognized as a central component of Alzheimer's disease. Surprisingly, however, the structural status of glutamatergic synapses in Alzheimer's disease is unclear, despite the fact that glutamate is the major excitatory transmitter of the CNS and has key roles in excitotoxicity and long-term potentiation. The identification of specific markers of glutamatergic neurons now allows an assessment of the structural involvement of the glutamatergic system across progressive stages of the Alzheimer's pathology, an opportunity not afforded by previously used neurochemical approaches. Glutamatergic presynaptic bouton density and dystrophic neurite abundance were quantified in midfrontal gyrus brain tissue from subjects with no cognitive impairment, mild cognitive impairment, or mild- or severe-stage Alzheimer's disease. Our study demonstrates a striking pathology-dependent pattern of glutamatergic synaptic remodeling with disease progression. Subjects with mild cognitive impairment display a paradoxical elevation in glutamatergic presynaptic bouton density, a situation akin to that observed in the cholinergic system, which then depletes and drops with disease progression. This pattern of synaptic remodeling mirrors our previous findings in transgenic animal models and is of major relevance to current transmitter-based therapeutics.

  2. The Role of Oxidative Stress in Etiopathogenesis of Chemotherapy Induced Cognitive Impairment (CICI)-“Chemobrain”

    PubMed Central

    Gaman, Amelia Maria; Uzoni, Adriana; Popa-Wagner, Aurel; Andrei, Anghel; Petcu, Eugen-Bogdan

    2016-01-01

    Chemobrain or chemotherapy induced cognitive impairment (CICI) represents a new clinical syndrome characterised by memory, learning and motor function impairment. As numerous patients with cancer are long-term survivors, CICI represent a significant factor which may interfere with their quality of life. However, this entity CICI must be distinguished from other cognitive syndromes and addressed accordingly. At the present time, experimental and clinical research suggests that CICI could be induced by numerous factors including oxidative stress. This type of CNS injury has been previously described in cancer patients treated with common anti-neoplastic drugs such as doxorubicine, carmustine, methotrexate and cyclophosphamide. It seems that all these pharmacological factors promote neuronal death through a final common pathway represented by TNF alpha (tumour necrosis factor). However, as cancer in general is diagnosed more commonly in the aging population, the elderly oncological patient must be treated with great care since aging per se is also impacted by oxidative stress and potentiually by TNF alpha deleterious action on brain parenchyma. In this context, some patients may develop cognitive dysfunction well before the appearance of CICI. In addition, chemotherapy may worsen their cognitive function. Therefore, at the present time, there is an acute need for development of effective therapeutic methods to prevent CICI as well as new methods of early CICI diagnosis. PMID:27330845

  3. Anosognosia and Anosodiaphoria in Mild Cognitive Impairment and Alzheimer's Disease

    PubMed Central

    Lindau, Maria; Bjork, Randall

    2014-01-01

    Aims To evaluate the occurrence of anosognosia (lack of awareness) and anosodiaphoria (insouciance) in mild cognitive impairment (MCI) and Alzheimer's disease (AD) and to evaluate the influence of a worsening of dementia on these phenomena. Methods A self-evaluation scale was used assessing degrees of anosognosia and anosodiaphoria; furthermore, a neuropsychological assessment and statistical analyses with nonparametric tests which could cope with data on an ordinal scale level and small samples were employed. Results Cognitive ability was lower in AD (n = 9) than in MCI patients (n = 12), but AD patients self-rated lower cognitive disabilities, which is interpreted as one relative sign of anosognosia in AD. Awareness of the reasons for cognitive problems was also lower in AD, which is considered as another sign of anosognosia. The main pattern in MCI found that the higher the awareness, the lower the cognitive ability. In AD low awareness paralleled low cognitive functioning. Anosodiaphoria was present in AD but not in MCI. Conclusion According to the literature anosognosia and anosodiaphoria seem to increase with progression of dementia from MCI as a result of right hemispheric alterations. PMID:25759713

  4. Impaired cognitive performance and hippocampal atrophy in Parkinson disease.

    PubMed

    Yildiz, Demet; Erer, Sevda; Zarifoğlu, Mehmet; Hakyemez, Bahattin; Bakar, Mustafa; Karli, Necdet; Varlibaş, Zeynep Nigar; Tufan, Fatih

    2015-01-01

    Dementia is common in Parkinson disease (PD). Since magnetic resonance imaging has been used, hippocampal atrophy has been shown in PD patients with or without dementia. In this study we sought the correlation of cognitive decline with bilateral hippocampal volume in PD patients. Thirty-three patients with diagnosis of idiopathic PD and 16 healthy subjects were included in this study. PD patients were divided into two groups as normal cognitive function and mild cognitive impairment (MCI). The Mini-Mental State Examination and detailed cognitive assessment tests were performed for all patients for cognitive analyses. Depression was excluded by the Geriatric Depression Scale. The mean onset age of disease was 55 years for PD patients without dementia and 59 for PD patients with MCI. According to the Hoehn-Yahr scales, 24% of patients had grade 1, 58% had grade 2, and 18% had grade 3 disease. Right and left hippocampal volumes decreased along with cognitive test scores in PD patients. Increased right hippocampal volume was correlated with forward number test in the MCI-PD group. These findings suggest that memory deficit is associated with hippocampal atrophy in PD patients.

  5. Perceptions of a cognitive rehabilitation group by older people living with cognitive impairment and their caregivers: A qualitative interview study.

    PubMed

    Moebs, Isabelle; Gee, Susan; Miyahara, Motohide; Paton, Helen; Croucher, Matthew

    2015-10-08

    Cognitive rehabilitation has been developed to improve quality of life, activities of daily living and mood for people with cognitive impairment, but the voice of people with cognitive impairment has been underrepresented. This study aimed to understand the experience of people living with cognitive impairment, as well as their caregivers who took part in a cognitive rehabilitation intervention programme. Twelve individuals with cognitive impairment and 15 caregivers participated in individual qualitative interviews. The interview data were analysed in three steps: 1) familiarisation of the transcripts; 2) identification of themes; 3) re-interpretation, refinement and integration of themes with methodological auditors. Both participants living with cognitive impairment and caregivers valued the comfortable environment with friendly, caring and supportive group leaders who taught practical tips and strategies. The participants living with cognitive impairment enjoyed socialising with like others. Caregivers benefited from learning about memory problems and sharing their challenges with other caregivers. The participants living with cognitive impairment emphasised the benefits of relational and practical aspects, whereas the caregivers valued the informational and emotional support. In conclusion, both participants living with cognitive impairment and caregivers found the cognitive rehabilitation group useful.

  6. Mild cognitive impairment: a subset of minor neurocognitive disorder?

    PubMed

    Geda, Yonas E; Nedelska, Zuzana

    2012-10-01

    The field of aging and dementia is increasingly preoccupied with identification of the asymptomatic phenotype of Alzheimer disease (AD). A quick glance at historical landmarks in the field indicates that the agenda and priorities of the field have evolved over time. The initial focus of research was dementia. In the late 1980s and 1990s, dementia researchers reported that some elderly persons are neither demented nor cognitively normal. Experts coined various terms to describe the gray zone between normal cognitive aging and dementia, including mild cognitive impairment. Advances made in epidemiologic, neuroimaging, and biomarkers research emboldened the field to seriously pursue the avenue of identifying asymptomatic AD. Accurate "diagnosis" of the phenotype has also evolved over time. For example, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Task Force is contemplating to use the terms major and minor neurocognitive disorders. The six papers published in this edition of the journal pertain to mild cognitive impairment, which is envisaged to become a subset of minor neurocognitive disorders. These six studies have three points in common: 1) All of them are observational studies; 2) they have generated useful hypotheses or made important observations without necessarily relying on expensive biomarkers; and 3) Based on the new National Institute on Aging and the Alzheimer's Association guidelines, all the studies addressed the symptomatic phase of AD. Questionnaire-based observational studies will continue to be useful until such a time that validated biomarkers, be it chemical or neuroimaging, become widely available and reasonably affordable.

  7. Neuroimaging correlates of cognitive impairment and dementia in Parkinson's disease.

    PubMed

    Mak, Elijah; Su, Li; Williams, Guy B; O'Brien, John T

    2015-08-01

    There has been a gradual shift in the definition of Parkinson's disease, from a movement disorder to a neurodegenerative condition affecting multiple cognitive domains. Mild cognitive impairment (PD-MCI) is a frequent comorbidity in PD that is associated with progression to dementia (PDD) and debilitating consequences for patients and caregivers. At present, the pathophysiology underpinning cognitive impairment in PD is not established, although emerging evidence has suggested that multi-modal imaging biomarkers could be useful in the early diagnosis of PD-MCI and PDD, thereby identifying at-risk patients to enable treatment at the earliest stage possible. Structural MRI studies have revealed prominent grey matter atrophy and disruptions of white matter tracts in PDD, although findings in non-demented PD have been more variable. There is a need for further longitudinal studies to clarify the spatial and temporal progression of morphological changes in PD, as well as to assess their underlying involvement in the evolution of cognitive deficits. In this review, we discuss the aetiology and neuropsychological profiles of PD-MCI and PDD, summarize the putative imaging substrates in light of evidence from multi-modal neuroimaging studies, highlight limitations in the present literature, and suggest recommendations for future research.

  8. Increased Matrix Metalloproteinase-9 Activity in Mild Cognitive Impairment

    PubMed Central

    Bruno, Martin A.; Mufson, Elliott J.; Wuu, Joanne; Cuello, A. Claudio

    2010-01-01

    Nerve growth factor (NGF)-dependent cholinergic basal forebrain neurons degenerate during the progression of Alzheimer disease (AD). Elevated proNGF and reduced levels of the TrkA high-affinity NGF receptor occur in prodromal and advanced stages of AD. We recently described a protease cascade responsible for the conversion of proNGF to mature NGF (mNGF) in which matrix metalloproteinase 9 (MMP-9) degrades mNGF in the extracellular space. To determine whether this proteolytic cascade is altered during the progression of AD, we examined human frontal and parietal cortex tissue from aged subjects with a clinical diagnosis of AD, mild cognitive impairment (MCI) or no cognitive impairment (NCI). The analysis demonstrated greater MMP-9 activity in both AD and MCI compared to NCI brain samples (p < 0.01), which supports the notion that a metabolic failure in the NGF-maturation/degradation pathway may be associated with an exacerbated degradation of mNGF in the cerebral cortex in early AD. Moreover, there were inverse correlations between Global Cognitive Score and Mini-Mental State Examination score and MMP-9 activity. These findings suggest that a reduction in mNGF as a consequence of MMP-9-mediated degradation may in part underlie the pathogenesis of cognitive deficits in MCI and AD. PMID:19915485

  9. Tocopherols and tocotrienols plasma levels are associated with cognitive impairment.

    PubMed

    Mangialasche, Francesca; Xu, Weili; Kivipelto, Miia; Costanzi, Emanuela; Ercolani, Sara; Pigliautile, Martina; Cecchetti, Roberta; Baglioni, Mauro; Simmons, Andrew; Soininen, Hilkka; Tsolaki, Magda; Kloszewska, Iwona; Vellas, Bruno; Lovestone, Simon; Mecocci, Patrizia

    2012-10-01

    Vitamin E includes 8 natural compounds (4 tocopherols, 4 tocotrienols) with potential neuroprotective activity. α-Tocopherol has mainly been investigated in relation to cognitive impairment. We examined the relation of all plasma vitamin E forms and markers of vitamin E damage (α-tocopherylquinone, 5-nitro-γ-tocopherol) to mild cognitive impairment (MCI) and Alzheimer's disease (AD). Within the AddNeuroMed-Project, plasma tocopherols, tocotrienols, α-tocopherylquinone, and 5-nitro-γ-tocopherol were assessed in 168 AD cases, 166 MCI, and 187 cognitively normal (CN) people. Compared with cognitively normal subjects, AD and MCI had lower levels of total tocopherols, total tocotrienols, and total vitamin E. In multivariable-polytomous-logistic regression analysis, both MCI and AD cases had 85% lower odds to be in the highest tertile of total tocopherols and total vitamin E, and they were, respectively, 92% and 94% less likely to be in the highest tertile of total tocotrienols than the lowest tertile. Further, both disorders were associated with increased vitamin E damage. Low plasma tocopherols and tocotrienols levels are associated with increased odds of MCI and AD. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Social cognition impairments in Asperger syndrome and schizophrenia.

    PubMed

    Lugnegård, Tove; Unenge Hallerbäck, Maria; Hjärthag, Fredrik; Gillberg, Christopher

    2013-02-01

    Social cognition impairments are well described in both autism spectrum disorders, including Asperger syndrome (AS), and in schizophrenia spectrum disorders. However, little is known about whether there are differences between the two groups of disorders regarding this ability. The aim of this study was to compare social cognition abilities in AS and schizophrenia. Fifty-three individuals (26 men, 27 women) with a clinical diagnosis of AS, 36 (22 men, 14 women) with a clinical diagnosis of schizophrenic psychosis, and 50 non-clinical controls (19 men, 31 women) participated in the study. Clinical diagnoses were confirmed either by Structured Clinical Interview on DSM-IV diagnosis or the Diagnostic Interview for Social and Communication Disorders. Verbal ability was assessed using the Vocabulary subtest of the WAIS-III. Two social cognition instruments were used: Reading the Mind in the Eyes Test (Eyes Test) and the Animations Task. On the Eyes Test, patients with schizophrenia showed poorer results compared to non-clinical controls; however, no other group differences were seen. Both clinical groups scored significantly lower than the comparison group on the Animations Task. The AS group performed somewhat better than the schizophrenia group. Some differences were accounted for by gender effects. Implicit social cognition impairments appear to be at least as severe in schizophrenia as they are in AS. Possible gender differences have to be taken into account in future research on this topic.

  11. Suspected non-AD pathology in mild cognitive impairment.

    PubMed

    Wisse, Laura E M; Butala, Nirali; Das, Sandhitsu R; Davatzikos, Christos; Dickerson, Bradford C; Vaishnavi, Sanjeev N; Yushkevich, Paul A; Wolk, David A

    2015-12-01

    We aim to better characterize mild cognitive impairment (MCI) patients with suspected non-Alzheimer's disease (AD) pathology (SNAP) based on their longitudinal outcome, cognition, biofluid, and neuroimaging profile. MCI participants (n = 361) from ADNI-GO/2 were designated "amyloid positive" with abnormal amyloid-beta 42 levels (AMY+) and "neurodegeneration positive" (NEU+) with abnormal hippocampal volume or hypometabolism using fluorodeoxyglucose-positron emission tomography. SNAP was compared with the other MCI groups and with AMY- controls. AMY-NEU+/SNAP, 16.6%, were older than the NEU- groups but not AMY- controls. They had a lower conversion rate to AD after 24 months than AMY+NEU+ MCI participants. SNAP-MCI participants had similar amyloid-beta 42 levels, florbetapir and tau levels, but larger white matter hyperintensity volumes than AMY- controls and AMY-NEU- MCI participants. SNAP participants performed worse on all memory domains and on other cognitive domains, than AMY-NEU- participants but less so than AMY+NEU+ participants. Subthreshold levels of cerebral amyloidosis are unlikely to play a role in SNAP-MCI, but pathologies involving the hippocampus and cerebrovascular disease may underlie the neurodegeneration and cognitive impairment in this group.

  12. Geriatric depression and its relation with cognitive impairment and dementia.

    PubMed

    Dillon, Carol; Tartaglini, María Florencia; Stefani, Dorina; Salgado, Pablo; Taragano, Fernando E; Allegri, Ricardo F

    2014-01-01

    Different subtypes of depressive syndromes exist in late life; many of them have cognitive impairment and sometimes it is difficult to differentiate them from dementia. This research aimed to investigate subtypes of geriatric depression associated with cognitive impairment, searched for differential variables and tried to propose a study model. A hundred and eighteen depressive patients and forty normal subjects matched by age and educational level were evaluated with an extensive neuropsychological battery, scales to evaluate neuropsychiatric symptoms and daily life activities (DLA). Depressive patients were classified in groups by SCAN 2.1: Major Depression Disorder (MDD) (n: 31), Dysthymia Disorder (DD) (n: 31), Subsyndromal Depression Disorder (SSD) (n: 29), Depression due to Dementia (n: 27) (DdD). Neuropsychological significant differences (p<0.05) were observed between depressive groups, demonstrating distinctive cognitive profiles. Moreover, significant differences (p<0.05) were found in DLA between DdD vs all groups and MDD vs controls and vs SSD. Age of onset varied in the different subtypes of depression. Beck Depression Inventory (BDI) and Mini Mental State Examination (MMSE) were significant variables that helped to differentiate depressive groups. Significant correlations between BDI and Neuropsychological tests were found in MDD and DD groups. Depressive symptoms and its relation with neuropsychological variables, MMSE, cognitive profiles, DLA and age of onset of depression should be taken into consideration for the study of subtypes of geriatric depression. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. Transient global amnesia--full recovery without persistent cognitive impairment.

    PubMed

    Uttner, I; Weber, S; Freund, W; Schmitz, B; Ramspott, M; Huber, R

    2007-01-01

    Transient global amnesia (TGA) is a clinical syndrome of unknown etiology characterized by sudden onset anterograde amnesia, which was thought to resolve completely. However, some authors have also suggested permanent memory impairment. It is unclear whether these results reflect a true persistent damage or a simply too short assessment interval in the context of a prolonged recovery phase after TGA. To evaluate the cognitive long-term outcome, 16 patients who had suffered from TGA at a mean of 3 years before and 15 healthy controls underwent a comprehensive neuropsychological test battery. No significant differences between patients' and controls' cognitive performance were found, irrespectively of the analyzed neuropsychological domain. Therefore we hypothesize that TGA usually does not cause persistent cognitive deficits due to a generally transient and prognostic benign character.

  14. Self-Awareness for Memory Impairment in Amnestic Mild Cognitive Impairment: A Longitudinal Study.

    PubMed

    Cova, Ilaria; Grande, Giulia; Cucumo, Valentina; Ghiretti, Roberta; Maggiore, Laura; Galimberti, Daniela; Scarpini, Elio; Mariani, Claudio; Pomati, Simone

    2017-11-01

    To assess memory impairment insight as a predictor of dementia and Alzheimer's disease (AD) in amnestic mild cognitive impairment (MCI). To verify whether the awareness of memory impairment assessed by Geriatric Depression Scale (GDS) was associated with the risk of progression to dementia and AD in a cohort of MCI, we used a Cox regression model adjusted for age, sex, education, subtypes of amnestic MCI, Mini-Mental State Examination, Cumulative Illness Rating Scale severity index, and apolipoprotein E genotype. During a follow-up of 27.7 (20.8) months, 205 (63.3%) of 324 patients with amnestic MCI progressed to dementia, including 141 to AD. No association was found in the unadjusted, partially adjusted (for sociodemographic variables), and fully adjusted multivariate Cox analysis between the awareness of memory impairment and the progression to dementia and AD. Awareness or anosognosia of memory deficits, identified by GDS, is not useful to predict progression to dementia of patients with amnestic MCI.

  15. Modelling Alzheimer-like cognitive deficits in rats using biperiden as putative cognition impairer.

    PubMed

    Szczodry, Olga; van der Staay, Franz Josef; Arndt, Saskia S

    2014-11-01

    To enable the development of effective treatments for dementias such as Alzheimer's disease (AD), it is important to establish valid animal models of cognitive impairments. Scopolamine is widely used to induce cognitive deficits in animal models of AD, but also causes non-cognitive side effects. We assessed whether biperiden, a selective antagonist of M1 muscarinic receptors, which are predominantly expressed in brain areas involved in cognitive processes, causes cognitive deficits without inducing peripheral side-effects. Two different doses of biperiden (3 or 10mgkg(-1)) on the acquisition of a spatial cone field task were assessed in male Lister Hooded rats. This task measures, among others, spatial working (WM) - and reference memory (RM) simultaneously. Biperiden did not impair learning of the task. The animals reached asymptotic levels for all variables except reference memory and the number of rewards collected. However, the 10mgkg(-1) dose decreased the tendency of rats to use searching strategies to solve the task and made them slower to start searching and completing the task. In conclusion, though no effects on WM and RM performance were seen, the present study cannot conclude that biperiden acts as a more selective cognition impairer than scopolamine in other rats strains and/or other doses than those tested.

  16. Cognitive Correlates of Timed Up and Go Subtasks in Older People With Preserved Cognition, Mild Cognitive Impairment, and Alzheimer's Disease.

    PubMed

    Ansai, Juliana Hotta; Andrade, Larissa Pires de; Nakagawa, Theresa Helissa; Vale, Francisco Assis Carvalho; Caetano, Maria Joana Duarte; Lord, Stephen Ronald; Rebelatto, José Rubens

    2017-10-01

    To determine whether impaired Timed Up and Go Test (TUG) subtask performances are associated with specific cognitive domains among older people with preserved cognition (PC), mild cognitive impairment (MCI), and mild Alzheimer's disease (AD). TUG subtasks performances were assessed by the Qualisys motion system. Cognition was assessed by Addenbrooke's Cognitive Examination and the Frontal Assessment Battery (FAB). The highest correlations with transition subtasks were with aspects of executive function, i.e. the fluency domain in the PC group (n = 40), FAB scores in the MCI group (n = 40), and the visuospatial domain in the AD group (n = 38). No significant associations were found between the walking subtasks and cognition in any group. Multivariate linear regression models identified the fluency domain as an independent predictor of turn-to-walk and turn-to-sit measures in the PC group, and the visuospatial domain as an independent predictor of turn-to-walk and turn-to-sit measures in the AD group, adjusted for age and sex. Poorer executive functioning was associated with impaired transition mobility in all groups. The significant associations between visuospatial impairment and poor transition mobility in the AD participants may provide insight into why this group has an elevated fall risk.

  17. Cognitive Training among Cognitively Impaired Older Adults: A Feasibility Study Assessing the Potential Improvement in Balance.

    PubMed

    Smith-Ray, Renae L; Irmiter, Cheryl; Boulter, Kristin

    2016-01-01

    Emerging literature suggests that mobility and cognition are linked. Epidemiological data support a negative association between cognition and falls among cognitively intact older adults. A small number of intervention studies found that regimented cognitive training (CT) improves mobility among this population, suggesting that CT may be an under-explored approach toward reducing falls. To date, no studies have examined the impact of CT on balance among those who are cognitively impaired. The purpose of this study was to assess the feasibility of implementing a CT program among cognitively impaired older adults and examine whether there are potential improvements in balance following CT. A single group repeated measures design was used to identify change in balance, depressive symptoms, and global cognition. A mixed method approach was employed to evaluate the feasibility of a CT intervention among a cohort of cognitively impaired older adults. CT was delivered in a group 2 days/week over 10 weeks using an online brain exercise program, Posit Science Brain HQ (20 h). All participants completed a one-on-one data collection interview at baseline and post-program. Participants (N = 20) were on average 80.5 years old and had mild to moderate cognitive impairment. Following the 10-week CT intervention, mean scores on 4 of the 5 balance measures improved among CT participants. Although none of the balance improvements reached significance, these findings are promising given the small sample size. Depressive symptoms significantly improved between baseline and 10 weeks (p = 0.021). Mean global cognition also improved across the study period, but neither of these improvements were statistically significant. Based on participant responses, the CT program was feasible for this population. This study provides support for the feasibility of implementing a CT program among cognitively impaired older adults in an adult day setting. Our findings also add to

  18. Cognitive training changes hippocampal function in mild cognitive impairment: a pilot study.

    PubMed

    Rosen, Allyson C; Sugiura, Lisa; Kramer, Joel H; Whitfield-Gabrieli, Susan; Gabrieli, John D

    2011-01-01

    A randomized pilot experiment examined the neural substrates of response to cognitive training in participants with mild cognitive impairment (MCI). Participants performed exercises previously demonstrated to improve verbal memory and an active control group performed other computer activities. An auditory-verbal fMRI task was conducted before and after the two-month training program. Verbal memory scores improved significantly and left hippocampal activation increased significantly in the experimental group (gains in 5 of 6 participants) relative to the control group (reductions in all 6 participants). Results suggest that the hippocampus in MCI may retain sufficient neuroplasticity to benefit from cognitive training.

  19. Cognitive Training Changes Hippocampal Function in Mild Cognitive Impairment: A Pilot Study

    PubMed Central

    Rosen, Allyson C.; Sugiura, Lisa; Kramer, Joel H.; Whitfield-Gabrieli, Susan; Gabrieli, John D.

    2012-01-01

    A randomized pilot experiment examined the neural substrates of response to cognitive training in participants with mild cognitive impairment (MCI). Participants performed exercises previously demonstrated to improve verbal memory and an active control group performed other computer activities. An auditory-verbal fMRI task was conducted before and after the two-month training program. Verbal memory scores improved significantly and left hippocampal activation increased significantly in the experimental group (gains in 5 of 6 participants) relative to the control group (reductions in all 6 participants). Results suggest that the hippocampus in MCI may retain sufficient neuroplasticity to benefit from cognitive training. PMID:21971474

  20. The patterns of cognitive and functional impairment in amnestic and non-amnestic mild cognitive impairment in geriatric depression.

    PubMed

    Reinlieb, Michelle; Ercoli, Linda M; Siddarth, Prabha; St Cyr, Natalie; Lavretsky, Helen

    2014-12-01

    Depressed older adults are at risk for the development of mild cognitive impairment (MCI), but few studies have characterized MCI subtypes in geriatric depression. The objective of this study was to identify the clinical patterns of MCI in late-life depression. Baseline demographic, clinical, and neuropsychological test data collected as part of a randomized antidepressant trial for geriatric depression. UCLA-based outpatient clinic. One hundred thirty-eight older adults with major depression. A neuropsychological test battery and comprehensive evaluations of depression, apathy, quality of life, medical burden, and vascular risk factors. Seventy-one participants (51%) had MCI and 67 (49%) were cognitively normal. Of subjects with MCI, 14 (20%) had amnestic MCI and 57 (80%) had non-amnestic MCI. Overall, patients with MCI had greater depression severity, poorer quality of life, and worse performance on the Mini-Mental State Exam than patients without MCI. Patients with non-amnestic MCI had significantly greater depression severity than patients without MCI. Across all subjects, depression severity correlated with impaired performance in language and visuospatial functioning. Our findings suggest that MCI is associated with greater severity of depression, poorer quality of life, and worse global cognitive function. Overall, subtypes of MCI in geriatric depression differ in the patterns of functional impairment, which may require different therapeutic approaches. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  1. Glutamate Networks Implicate Cognitive Impairments in Schizophrenia: Genome-Wide Association Studies of 52 Cognitive Phenotypes

    PubMed Central

    Ohi, Kazutaka; Hashimoto, Ryota; Ikeda, Masashi; Yamamori, Hidenaga; Yasuda, Yuka; Fujimoto, Michiko; Umeda-Yano, Satomi; Fukunaga, Masaki; Fujino, Haruo; Watanabe, Yoshiyuki; Iwase, Masao; Kazui, Hiroaki; Iwata, Nakao; Weinberger, Daniel R.; Takeda, Masatoshi

    2015-01-01

    Cognitive impairments are a core feature in patients with schizophrenia. These deficits could serve as effective tools for understanding the genetic architecture of schizophrenia. This study investigated whether genetic variants associated with cognitive impairments aggregate in functional gene networks related to the pathogenesis of schizophrenia. Here, genome-wide association studies (GWAS) of a range of cognitive phenotypes relevant to schizophrenia were performed in 411 healthy subjects. We attempted to replicate the GWAS data using 257 patients with schizophrenia and performed a meta-analysis of the GWAS findings and the replicated results. Because gene networks, rather than a single gene or genetic variant, may be strongly associated with the susceptibility to schizophrenia and cognitive impairments, gene-network analysis for genes in close proximity to the replicated variants was performed. We observed nominal associations between 3054 variants and cognitive phenotypes at a threshold of P < 1.0 × 10− 4. Of the 3054 variants, the associations of 191 variants were replicated in the replication samples (P < .05). However, no variants achieved genome-wide significance in a meta-analysis (P > 5.0 × 10− 8). Additionally, 115 of 191 replicated single nucleotide polymorphisms (SNPs) have genes located within 10 kb of the SNPs (60.2%). These variants were moderately associated with cognitive phenotypes that ranged from P = 2.50 × 10− 5 to P = 9.40 × 10− 8. The genes located within 10 kb from the replicated SNPs were significantly grouped in terms of glutamate receptor activity (false discovery rate (FDR) q = 4.49 × 10− 17) and the immune system related to major histocompatibility complex class I (FDR q = 8.76 × 10− 11) networks. Our findings demonstrate that genetic variants related to cognitive trait impairment in schizophrenia are involved in the N-methyl-d-aspartate glutamate network. PMID:25537281

  2. Montreal cognitive assessment: validation study for mild cognitive impairment and Alzheimer disease.

    PubMed

    Freitas, Sandra; Simões, Mário Rodrigues; Alves, Lara; Santana, Isabel

    2013-01-01

    The Montreal Cognitive Assessment (MoCA) was recently proposed as a cognitive screening test for milder forms of cognitive impairment, having surpassed the well-known limitations of the Mini-Mental State Examination (MMSE). This study aims to validate the MoCA for screening Mild Cognitive Impairment (MCI) and Alzheimer disease (AD) through an analysis of diagnostic accuracy and the proposal of cut-offs. Patients were classified into 2 clinical groups according to standard criteria: MCI (n=90) and AD (n=90). The 2 control groups (C-MCI: n=90; C-AD: n=90) consisted of cognitively healthy community dwellers selected to match patients in sex, age, and education. The MoCA showed consistently superior psychometric properties compared with the MMSE, and higher diagnostic accuracy to discriminate between MCI (area under the curve=0.856; 95% confidence interval, 0.796-0.904) and AD patients (area under the curve=0.980; 95% confidence interval, 0.947-0.995). At an optimal cut-off of below 22 for MCI and below 17 for AD, the MoCA achieved significantly superior values in comparison with MMSE for sensitivity, specificity, positive predictive value, negative predictive value, and classification accuracy. Furthermore, the MoCA revealed higher sensitivity to cognitive decline in longitudinal monitoring. This study provides robust evidence that the MoCA is a better cognitive tool than the widely used MMSE for the screening and monitoring of MCI and AD in clinical settings.

  3. Prevalence of cortical superficial siderosis in patients with cognitive impairment.

    PubMed

    Wollenweber, Frank Arne; Buerger, Katharina; Mueller, Claudia; Ertl-Wagner, Birgit; Malik, Rainer; Dichgans, Martin; Linn, Jennifer; Opherk, Christian

    2014-02-01

    Cortical superficial siderosis (cSS) is a magnetic resonance imaging marker of cerebral amyloid angiopathy (CAA) and can be its sole imaging sign. cSS has further been identified as a risk marker for future intracranial hemorrhage. Although uncommon in the general population, cSS may be much more prevalent in high risk populations for amyloid pathology. We aimed to determine the frequency of cSS in patients with cognitive impairment presenting to a memory clinic. We prospectively evaluated consecutive patients presenting to our memory clinic between April 2011 and April 2013. Subjects received neuropsychological testing using the Consortium to Establish a Registry for Alzheimer's Disease battery (CERAD-NP). Two hundred and twelve patients with documented cognitive impairment further underwent a standardized 3T-MR-imaging protocol with T2*-weighted gradient-echo sequences for detection of cSS. Thirteen of 212 patients (6.1 %) displayed cSS. In seven of them (54 %) cSS was the only imaging sign of CAA. Patients with cSS did not differ from patients without cSS with regard to medical history, age or cardiovascular risk profile. Subjects with cSS performed worse in the mini-mental state examination (p = 0.001), showed more white matter hyperintensities (p = 0.005) and more often had microbleeds (p = 0.001) compared to those without cSS. cSS is common in patients with cognitive impairment. It is associated with lower cognitive scores, white matter hyperintensities and microbleeds and can be the only imaging sign for CAA in this patient group.

  4. [Cognitive training interventions for normal aging, mild cognitive impairment and Alzheimer's].

    PubMed

    Bier, Nathalie; Desrosiers, Johanne; Gagnon, Lise

    2006-02-01

    In the past few years, occupational therapists have been increasingly working with geriatric clients and have used interventions focused on enhancing independance and quality of life. In this area of practice, the cognitive training intervention aimed more specifically at memory disorders, is a promising intervention for the area of aging and occupational therapy. The aim of this literature review is to present an overview of the fundamentals, objectives and procedures of the cognitive training intervention used with the following populations: aging people presenting a memory disorder associated with normal aging with mild cognitive impairment or with Alzheimer's disease. A discussion on the cognitive management of memory is presented with respect to the cognitive characteristics of each of these clients.

  5. A Combined Training Program for Veterans with Amnestic Mild Cognitive Impairment

    DTIC Science & Technology

    2015-10-01

    AWARD NUMBER: W81XWH-12-1-0584 TITLE: A Combined Training Program for Veterans with Amnestic Mild Cognitive Impairment PRINCIPAL INVESTIGATOR...Sept 2014 – 26 Sept 2015 4. TITLE AND SUBTITLE A Combined Training Program for Veterans with Amnestic Mild Cognitive Impairment 5a. CONTRACT NUMBER...augmentation for cognitive training intervention to improve memory performance in older Veterans with a diagnosis of amnestic Mild Cognitive Impairment

  6. Metabolic and endocrine factors in mild cognitive impairment.

    PubMed

    Etgen, Thorleif; Bickel, Horst; Förstl, Hans

    2010-07-01

    Mild cognitive impairment (MCI) is a heterogeneous condition with cognitive changes between normal aging and dementia. Some forms of MCI are regarded as potential preclinical forms of dementia. The control of treatable somatic risk factors is of great relevance in patients with MCI, particularly as there is insufficient evidence for the efficacy of interventions targeting neurodegenerative processes, as used in manifest dementia. The etiology of MCI is varied including cerebrovascular risk factors and is also associated with metabolic and endocrine factors. Chronic kidney disease is a newly identified and independent risk factor for MCI. Testosterone substitution is useful if a low testosterone level is present but general screening for testosterone deficiency is not yet recommended. A relationship between MCI and vitamin D or subclinical thyroid dysfunction may exist, but the value of substitution is doubtful and requires large randomized placebo-controlled trials. Although an association between vitamin B12 deficiency or hyperhomocysteinemia and MCI is present, substitution of vitamin B12 or folate does not appear to prevent cognitive decline. Estrogen-only hormone replacement therapy may be considered only in younger postmenopausal women, but may have detrimental effects on cognitive function in older postmenopausal women. Other less familiar or unknown risk factors contributing to cognitive dysfunction should be identified as they are a potential target of prevention or intervention of MCI or dementia. 2010 Elsevier Ireland Ltd. All rights reserved.

  7. Cognitive remediation for bipolar patients with objective cognitive impairment: a naturalistic study.

    PubMed

    Veeh, J; Kopf, J; Kittel-Schneider, S; Deckert, J; Reif, A

    2017-12-01

    Many bipolar patients (BP) are affected by cognitive impairments and reduced psychosocial function even after complete remission. In the present naturalistic study, we developed a tailored cognitive remediation program (CR) to evaluate the effect on objective and subjective neuropsychological performance, psychosocial functioning and quality of life. The CR program used a cognitive training software combined with group sessions to educate cognitive skills. 102 BP were screened by a neuropsychological test battery. Of those, 39 BP showed distinct cognitive impairments and 26 patients of them participated in the CR program for 12 weeks and then were retested. A matched control group consisting of 10 BP was measured at baseline and follow-up after three months (treatment as usual). Within the training group, a significant improvement of cognitive performance after CR was observed in working memory (p = .043), problem solving (p = .031) and divided attention (trend, p = .065). The control group did not improve in any test measure. In addition, we detected a significant reduction of sub-depressive symptoms (p = .011) after the CR program. However, there was no change in psychosocial functioning and quality of life. Subjective cognitive complaints were not associated with objective test performance. As we included exclusively BP with objectively assessed neurocognitive deficits, recruitment was difficult and subsequently we had a small sample size and were not able to implement a randomized group design. Our results suggest that BP with objective cognitive impairments could benefit from CR potentially with regard to executive functioning. Furthermore, there is preliminary evidence that CR could have a positive effect on subthreshold residual symptoms. However, to fully identify the possible implications of CR in bipolar disorder, larger randomized-controlled trials are needed in this new field of research.

  8. Domain-specific cognitive impairment in patients with COPD and control subjects

    PubMed Central

    Cleutjens, Fiona AHM; Franssen, Frits ME; Spruit, Martijn A; Vanfleteren, Lowie EGW; Gijsen, Candy; Dijkstra, Jeanette B; Ponds, Rudolf WHM; Wouters, Emiel FM; Janssen, Daisy JA

    2017-01-01

    Impaired cognitive function is increasingly recognized in COPD. Yet, the prevalence of cognitive impairment in specific cognitive domains in COPD has been poorly studied. The aim of this cross-sectional observational study was to compare the prevalence of domain-specific cognitive impairment between patients with COPD and non-COPD controls. A neuropsychological assessment was administered in 90 stable COPD patients and 90 non-COPD controls with comparable smoking status, age, and level of education. Six core tests from the Maastricht Aging Study were used to assess general cognitive impairment. By using Z-scores, compound scores were constructed for the following domains: psychomotor speed, planning, working memory, verbal memory, and cognitive flexibility. General cognitive impairment and domain-specific cognitive impairment were compared between COPD patients and controls after correction for comorbidities using multivariate linear and logistic regression models. General cognitive impairment was found in 56.7% of patients with COPD and in 13.3% of controls. Deficits in the following domains were more often present in patients with COPD after correction for comorbidities: psychomotor speed (17.8% vs 3.3%; P<0.001), planning (17.8% vs 1.1%; P<0.001), and cognitive flexibility (43.3% vs 12.2%; P<0.001). General cognitive impairment and impairments in the domains psychomotor speed, planning, and cognitive flexibility affect the COPD patients more than their matched controls. PMID:28031706

  9. Lidocaine attenuates cognitive impairment after isoflurane anesthesia in old rats.

    PubMed

    Lin, Daowei; Cao, Lin; Wang, Zhi; Li, Jiejie; Washington, Jacqueline M; Zuo, Zhiyi

    2012-03-17

    Post-operative cognitive dysfunction (POCD) is a clinical phenomenon that has drawn significant attention from the public and scientific community. Age is a risk factor for POCD. However, the contribution of general anesthesia/anesthetics to POCD and the underlying neuropathology are not clear. Here, we showed that 18-month-old male Fisher 344 rats exposed to 1.2% isoflurane, a general anesthetic, for 2h had significant learning and memory impairments assessed at 2-4 weeks after isoflurane exposure. These isoflurane effects were attenuated by intravenous lidocaine (1.5mg/kg as a bolus and then 2mg/kg/h during isoflurane exposure), a local anesthetic that has neuroprotective effect. Exposure to isoflurane or isoflurane plus lidocaine did not change the neuronal and synaptic density as well as the expression of NeuN (a neuronal protein), drebrin (a dendritic spine protein), synaptophysin (a synaptic protein), activated caspase 3 and caspase-activated DNase in the hippocampus at 29 days after isoflurane exposure when cognitive impairment was present. Isoflurane and lidocaine did not affect the amount of β-amyloid peptide, total tau and phospho-tau in the cerebral cortex as well as interleukin-1β and tumor necrosis factor-α in the hippocampus at 29 days after isoflurane exposure. Thus, isoflurane induces learning and memory impairment in old rats. Lidocaine attenuates these isoflurane effects. Isoflurane may not cause long-lasting neuropathological changes.

  10. Subjective Cognitive Impairment Subjects in Our Clinical Practice

    PubMed Central

    Garcia-Ptacek, Sara; Cavallin, Lena; Kåreholt, Ingemar; Kramberger, Milica Gregoric; Winblad, Bengt; Jelic, Vesna; Eriksdotter, Maria

    2014-01-01

    Background The clinical challenge in subjective cognitive impairment (SCI) is to identify which individuals will present cognitive decline. We created a statistical model to determine which variables contribute to SCI and mild cognitive impairment (MCI) versus Alzheimer's disease (AD) diagnoses. Methods A total of 993 subjects diagnosed at a memory clinic (2007-2009) were included retrospectively: 433 with SCI, 373 with MCI and 187 with AD. Descriptive statistics were provided. A logistic regression model analyzed the likelihood of SCI and MCI patients being diagnosed with AD, using age, gender, Mini-Mental State Examination score, the ratio of β-amyloid 42 divided by total tau, and phosphorylated tau as independent variables. Results The SCI subjects were younger (57.8 ± 8 years) than the MCI (64.2 ± 10.6 years) and AD subjects (70.1 ± 9.7 years). They were more educated, had less medial temporal lobe atrophy (MTA) and frequently normal cerebrospinal fluid biomarkers. Apolipoprotein E4/E4 homozygotes and apolipoprotein E3/E4 heterozygotes were significantly less frequent in the SCI group (6 and 36%) than in the AD group (28 and 51%). Within the regression model, cardiovascular risk factors, confluent white matter lesions, MTA and central atrophy increased the AD likelihood for SCI subjects. Conclusions SCI patients form a distinct group. In our model, factors suggesting cardiovascular risk, MTA and central atrophy increased the AD likelihood for SCI subjects. PMID:25538726

  11. Heart failure and cognitive impairment: Challenges and opportunities

    PubMed Central

    Heckman, George A; Patterson, Christopher J; Demers, Catherine; St.Onge, Joye; Turpie, Irene D; McKelvie, Robert S

    2007-01-01

    As populations age, heart failure (HF) is becoming increasingly common, and in addition to a high burden of morbidity and mortality, HF has an enormous financial impact. Though disproportionately affected by HF, the elderly are less likely to receive recommended therapies, in part because clinical trials of HF therapy have ignored outcomes of importance to this population, including impaired cognitive function (ICF). HF is associated with ICF, manifested primarily as delirium in hospitalized patients, or as mild cognitive impairment or dementia in otherwise stable outpatients. This association is likely the result of shared risk factors, as well as perfusion and rheological abnormalities that occur in patients with HF. Evidence suggests that these abnormalities may be partially reversible with standard HF therapy. The clinical consequences of ICF in HF patients are significant. Clinicians should consider becoming familiar with screening instruments for ICF, including delirium and dementia, in order to identify patients at risk of nonadherence to HF therapy and related adverse consequences. Preliminary evidence suggests that optimal HF therapy in elderly patients may preserve or even improve cognitive function, though the impact on related outcomes remains to be determined. PMID:18044137

  12. Neurocognitive testing supports a broader concept of mild cognitive impairment.

    PubMed

    Gualtieri, C Thomas; Johnson, Lynda G

    2005-01-01

    The narrow concept of mild cognitive impairment (MCI) as an early form of Alzheimer s disease has been broadened by research that established the existence of alternative forms of the condition that may presage other forms of dementia. The research presented here was a naturalistic, cross-sectional study of patients in a community referral clinic-patients with MCI and mild dementia-compared to normal controls. A comprehensive, computerized neurocognitive screening battery developed by one of the authors (CNS Vital Signs) was administered to all of the subjects. Participants consisted of 36 patients with MCI and 53 patients with mild dementia, diagnosed by standard criteria, and 89 matched normal controls. Multivariate analysis indicated significant differences among the three groups for all 15 primary test variables and for all five of the domain scores. Tests of memory, processing speed, and cognitive flexibility were the most cogent discriminators between normal controls and MCI patients, and between MCI patients and patients with mild dementia. The same three tests also had the greatest sensitivity and specificity. The results of this study indicate that computerized testing can differentiate among normal controls, MCI patients, and patients with mild dementia. Also, in a diverse group of MCI and mild dementia patients, impairments in memory, processing speed, and cognitive flexibility were the most prominent observed deficits.

  13. The Neurobiological Basis of Cognitive Impairment in Parkinson'S Disease

    PubMed Central

    Halliday, Glenda M.; Leverenz, James B.; Schneider, Jay S.; Adler, Charles H.

    2014-01-01

    The recent formalization of clinical criteria for PD with dementia (PD-D) codifies many studies on this topic, including those assessing biological correlates. These studies show that the emergence of PD-D occurs on the background of severe dopamine deficits with the main pathological drivers of cognitive decline being a synergistic effect between α -synuclein and Alzheimer's disease pathology. The presence of these pathologies correlates with a marked loss of limbic and cortically projecting dopamine, noradrenaline, serotonin and acetylcholine neurons, although the exact timing of these relationships remains to be determined. Genetic factors, such as triplications in the α-synuclein gene, lead to a clear increased risk of PD-D, while others, such as parkin mutations, are associated with a reduced risk of PD-D. The very recent formalization of clinical criteria for PD with mild cognitive impairment (PD-MCI) allows only speculation on its biological and genetic bases. Critical assessment of animal models shows that chronic low dose MPTP treatment in primates recapitulates PD-MCI over time, enhancing the current biological concept of PD-MCI as having enhanced dopamine deficiency in frontostriatal pathways as well as involvement of other neurotransmitter systems. Data from other animal models support multiple transmitter involvement in cognitive impairment in PD. While dopamine dysfunction has been highlighted because of its obvious role in PD, the role of the other neurotransmitter systems, neurodegenerative pathologies and genetic factors in PD-MCI remain to be fully elucidated. PMID:24757112

  14. Global Efficiency of Structural Networks Mediates Cognitive Control in Mild Cognitive Impairment

    PubMed Central

    Berlot, Rok; Metzler-Baddeley, Claudia; Ikram, M. Arfan; Jones, Derek K.; O’Sullivan, Michael J.

    2016-01-01

    Background: Cognitive control has been linked to both the microstructure of individual tracts and the structure of whole-brain networks, but their relative contributions in health and disease remain unclear. Objective: To determine the contribution of both localized white matter tract damage and disruption of global network architecture to cognitive control, in older age and Mild Cognitive Impairment (MCI). Materials and Methods: Twenty-five patients with MCI and 20 age, sex, and intelligence-matched healthy volunteers were investigated with 3 Tesla structural magnetic resonance imaging (MRI). Cognitive control and episodic memory were evaluated with established tests. Structural network graphs were constructed from diffusion MRI-based whole-brain tractography. Their global measures were calculated using graph theory. Regression models utilized both global network metrics and microstructure of specific connections, known to be critical for each domain, to predict cognitive scores. Results: Global efficiency and the mean clustering coefficient of networks were reduced in MCI. Cognitive control was associated with global network topology. Episodic memory, in contrast, correlated with individual temporal tracts only. Relationships between cognitive control and network topology were attenuated by addition of single tract measures to regression models, consistent with a partial mediation effect. The mediation effect was stronger in MCI than healthy volunteers, explaining 23-36% of the effect of cingulum microstructure on cognitive control performance. Network clustering was a significant mediator in the relationship between tract microstructure and cognitive control in both groups. Conclusion: The status of critical connections and large-scale network topology are both important for maintenance of cognitive control in MCI. Mediation via large-scale networks is more important in patients with MCI than healthy volunteers. This effect is domain-specific, and true for

  15. Global Efficiency of Structural Networks Mediates Cognitive Control in Mild Cognitive Impairment.

    PubMed

    Berlot, Rok; Metzler-Baddeley, Claudia; Ikram, M Arfan; Jones, Derek K; O'Sullivan, Michael J

    2016-01-01

    Background: Cognitive control has been linked to both the microstructure of individual tracts and the structure of whole-brain networks, but their relative contributions in health and disease remain unclear. Objective: To determine the contribution of both localized white matter tract damage and disruption of global network architecture to cognitive control, in older age and Mild Cognitive Impairment (MCI). Materials and Methods: Twenty-five patients with MCI and 20 age, sex, and intelligence-matched healthy volunteers were investigated with 3 Tesla structural magnetic resonance imaging (MRI). Cognitive control and episodic memory were evaluated with established tests. Structural network graphs were constructed from diffusion MRI-based whole-brain tractography. Their global measures were calculated using graph theory. Regression models utilized both global network metrics and microstructure of specific connections, known to be critical for each domain, to predict cognitive scores. Results: Global efficiency and the mean clustering coefficient of networks were reduced in MCI. Cognitive control was associated with global network topology. Episodic memory, in contrast, correlated with individual temporal tracts only. Relationships between cognitive control and network topology were attenuated by addition of single tract measures to regression models, consistent with a partial mediation effect. The mediation effect was stronger in MCI than healthy volunteers, explaining 23-36% of the effect of cingulum microstructure on cognitive control performance. Network clustering was a significant mediator in the relationship between tract microstructure and cognitive control in both groups. Conclusion: The status of critical connections and large-scale network topology are both important for maintenance of cognitive control in MCI. Mediation via large-scale networks is more important in patients with MCI than healthy volunteers. This effect is domain-specific, and true for

  16. Strength Training Decreases Inflammation and Increases Cognition and Physical Fitness in Older Women with Cognitive Impairment.

    PubMed

    Chupel, Matheus U; Direito, Fábio; Furtado, Guilherme E; Minuzzi, Luciéle G; Pedrosa, Filipa M; Colado, Juan C; Ferreira, José P; Filaire, Edith; Teixeira, Ana M

    2017-01-01

    Introduction: Cognitive impairment that affects older adults is commonly associated with an inflammatory imbalance, resulting in decreased physical fitness. Exercise has been pointed to mitigate immunosenescence and cognitive impairment associated with aging, while increase in physical fitness. However, few studies explored the relationship between changes in cytokine concentration and improvement on cognition due to elastic band strength training. The aim of this study was to investigate the effects of strength training on pro-and anti-inflammatory cytokines, hematological markers and physical fitness of older women with cognitive impairment. Methods: Thirty-three women (82.7 ± 5.7 years old) participated in the study and were divided in two groups: strength exercise training group (ST; n = 16) and Control Group (CG; n = 17) and were evaluated before and after 28 weeks of the exercise program. The CG did not undergo any type of exercise programs. Data for IL-10, TNF-α, IFN-γ, C-Reactive Protein (CRP), white blood counts (WBC), red blood counts (RBC), Mini Mental State Examination (MMSE) and physical fitness tests were analyzed in both moments. Results: IL-10 increased in the ST group without changes in CG. TNF-α and CRP increased in the control group while no changes were observed for IFN-γ in both groups. Strength training decreased leukocyte and lymphocyte counts and increase hemoglobin, mean cell volume and mean cell hemoglobin concentration. The MMSE score increased in strength training group but remained unchanged in the control group. A correlation between the variation of granulocyte counts and the MMSE scores was also observed within the total sample. An improvement in physical fitness was observed with strength training. Conclusion: Resistance exercise promoted better anti-inflammatory balance and physical performance simultaneously with an increase in cognitive profile in older women with cognitive impairment.

  17. Strength Training Decreases Inflammation and Increases Cognition and Physical Fitness in Older Women with Cognitive Impairment

    PubMed Central

    Chupel, Matheus U.; Direito, Fábio; Furtado, Guilherme E.; Minuzzi, Luciéle G.; Pedrosa, Filipa M.; Colado, Juan C.; Ferreira, José P.; Filaire, Edith; Teixeira, Ana M.

    2017-01-01

    Introduction: Cognitive impairment that affects older adults is commonly associated with an inflammatory imbalance, resulting in decreased physical fitness. Exercise has been pointed to mitigate immunosenescence and cognitive impairment associated with aging, while increase in physical fitness. However, few studies explored the relationship between changes in cytokine concentration and improvement on cognition due to elastic band strength training. The aim of this study was to investigate the effects of strength training on pro-and anti-inflammatory cytokines, hematological markers and physical fitness of older women with cognitive impairment. Methods: Thirty-three women (82.7 ± 5.7 years old) participated in the study and were divided in two groups: strength exercise training group (ST; n = 16) and Control Group (CG; n = 17) and were evaluated before and after 28 weeks of the exercise program. The CG did not undergo any type of exercise programs. Data for IL-10, TNF-α, IFN-γ, C-Reactive Protein (CRP), white blood counts (WBC), red blood counts (RBC), Mini Mental State Examination (MMSE) and physical fitness tests were analyzed in both moments. Results: IL-10 increased in the ST group without changes in CG. TNF-α and CRP increased in the control group while no changes were observed for IFN-γ in both groups. Strength training decreased leukocyte and lymphocyte counts and increase hemoglobin, mean cell volume and mean cell hemoglobin concentration. The MMSE score increased in strength training group but remained unchanged in the control group. A correlation between the variation of granulocyte counts and the MMSE scores was also observed within the total sample. An improvement in physical fitness was observed with strength training. Conclusion: Resistance exercise promoted better anti-inflammatory balance and physical performance simultaneously with an increase in cognitive profile in older women with cognitive impairment. PMID:28659812

  18. Early numerical abilities and cognitive skills in kindergarten children.

    PubMed

    Passolunghi, Maria Chiara; Lanfranchi, Silvia; Altoè, Gianmarco; Sollazzo, Nadia

    2015-07-01

    In this study, a unitary path analysis model was developed to investigate the relationship between cognitive variables (derived from published studies) and early numerical abilities in children attending the last year of kindergarten. We tested 100 children starting their last year of kindergarten on the following cognitive abilities: intelligence, phonological abilities, counting, verbal and visuospatial short-term memory and working memory, processing speed, and early numerical abilities. The same children were tested again on early numerical abilities at the end of the same year. The children's early numerical abilities at the beginning of the final year of kindergarten were found to be directly related to their verbal intelligence, phonological abilities, processing speed, and working memory and to be indirectly related to their nonverbal intelligence. Early numerical abilities at the end of the same year are directly related not only to early numerical abilities assessed at the beginning of the year but also to working memory and phonological abilities as well as have an indirect relationship with verbal and nonverbal intelligence. Overall, our results showed that both general and specific abilities are related to early mathematic learning in kindergarten-age children.

  19. Repeated Retrieval During Working Memory Is Sensitive to Amnestic Mild Cognitive Impairment

    PubMed Central

    Broster, Lucas S.; Li, Juan; Smith, Charles D.; Jicha, Gregory A.; Schmitt, Frederick A.; Jiang, Yang

    2013-01-01

    Study of repeated learning mechanisms has been limited in amnestic mild cognitive impairment, a preclinical stage of Alzheimer disease modifiable by cognitive rehabilitation. We assessed repeated contextual working memory decline as an indicator of amnestic mild cognitive impairment in a sample of 45 older adults recruited from the tertiary care setting. Results indicated that contextual working memory impairment distinguished adults with preclinical disease from those without impairment despite similar overall cognitive performance, and comparison of the indicator with standard-of-care neuropsychological measures indicated discriminant validity. Contextual working memory impairment may represent a novel predictor of Alzheimer disease conversion risk. PMID:24074205

  20. Awareness of cognitive deficits in older adults with epilepsy and mild cognitive impairment.

    PubMed

    Galioto, Rachel; Thamilavel, Selvan; Blum, Andrew S; Tremont, Geoffrey

    2015-01-01

    A significant portion of individuals with mild cognitive impairment (MCI) experience limited awareness of cognitive deficits. Although older adults with epilepsy have comparable cognitive deficits to individuals with MCI, little is known about awareness of cognitive deficit in epilepsy. This study compared deficit awareness in epilepsy and MCI and examined its relationship with neuropsychological performance. Sixty-two older adults (31 epilepsy, 31 MCI) completed neuropsychological testing and the Cognitive Difficulties Scale (CDS), a self-report measure of everyday cognitive skills. Informants completed the CDS only. Cognitive domain scores were created. CDS composite scores were created by summing attention-concentration and language and delayed memory factors. Awareness was defined as the difference between patient and informant CDS scores, with limited awareness defined as greater informant complaints. Neuropsychological performance was similar between groups for all domains except that MCI participants had worse delayed memory, t(60) = 2.49, p < .05. CDS scores were similar between patient groups (p > .05). Epilepsy informant CDS scores were related to poorer immediate memory (r = -.41, p = .02). MCI informant CDS scores were related to worse delayed memory (r = -.41, p = .02). Limited awareness was found in 29.0% of epilepsy and 61.3% of MCI participants. Awareness was not related to cognition in epilepsy but was related to worse delayed memory (r = -.41, p = .02) for MCI participants. Older adults with epilepsy and MCI had similar cognitive deficits with the exception of greater impairment in delayed memory for MCI patients. There was less awareness of deficit in the MCI group, suggesting that delayed memory may be a critical factor for deficit awareness. Results argue against executive dysfunction as a major contributor to deficit awareness.

  1. Early organiform impairment test (OFIT). A new performance test for assessment of early cognitive impairment.

    PubMed

    Amin, M M; Khan, P; Lehmann, H E; Mirmiran, J

    1985-01-01

    No satisfactory tests are available to a) document and b) monitor the short term effects of various pharmacological agents on early, and hopefully reversible, organic cognitive impairment in otherwise healthy individuals. A new test battery, Organiform Impairment Test (OFIT), is based on the clinical observation that impairment of the ability to operate simultaneously with a number of mental sets and stimuli is one of the first clinical manifestations in the early stages of organic brain pathology. This battery can be administered in 20-30 minutes and is partly automated. It has been standardized on 167 normal subjects in age ranges from 15 to 80 years. Any score below 50 on the battery in subjects under 80 years of age should be regarded with suspicion.

  2. Diagnostic accuracy of the RBANS in mild cognitive impairment: limitations on assessing milder impairments.

    PubMed

    Duff, Kevin; Hobson, Valerie L; Beglinger, Leigh J; O'Bryant, Sid E

    2010-08-01

    The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has demonstrated adequate sensitivity in detecting cognitive impairment in a number of neuropsychiatric conditions, including Alzheimer's disease. However, its ability to detect milder cognitive deficits in the elderly has not been examined. The current study examined the clinical utility of the RBANS by comparing two groups: Patients with Mild Cognitive Impairment (MCI; n = 72) and cognitively intact peers (n = 71). Significant differences were observed on the RBANS Total score, 3 of the 5 Indexes, and 6 of the 12 subtests, with individuals with MCI performing worse than the comparison participants. Specificity was very good, but sensitivity ranged from poor to moderate. Areas under the receiver operating characteristic curves for the RBANS Immediate and Delayed Memory Indexes and the Total Scale score were adequate. Although significant differences were observed between groups and the areas under the curves were adequate, the lower sensitivity values of the RBANS suggests that caution should be used when diagnosing conditions such as MCI.

  3. Influence of cognitive impairment, functional impairment and care setting on dementia care mapping results.

    PubMed

    Edelman, P; Kuhn, D; Fulton, B R

    2004-11-01

    Quality of life (QOL) for people with dementia has become a major focus over the past decade. Dementia care mapping (DCM) is an observational measure of quality of care given by staff in formal care settings, as well as a measure of QOL that has been used in many studies of people with dementia in residential care settings. However, the method itself has not been rigorously studied in a scientific manner. For this report, mapping data were collected for 166 persons with dementia in three types of care settings: special care facilities that are licensed nursing homes, assisted living facilities, and adult day centers. The relationships between DCM and several independent variables including cognitive status, functional status, care setting, depression, length of stay, and co-morbid illnesses were assessed. Both cognitive status and functional status were found to be associated with DCM scores. Moreover, DCM was sensitive in differentiating among persons with four levels of cognitive impairment. Implications for practice are discussed.

  4. Diabetes Mellitus, Cognitive Impairment, and Traditional Chinese Medicine

    PubMed Central

    Seto, S. W.; Yang, G. Y.; Kiat, H.; Bensoussan, A.; Kwan, Y. W.; Chang, D.

    2015-01-01

    Diabetes mellitus (DM) is a metabolic disorder affecting a large number of people worldwide. Numerous studies have demonstrated that DM can cause damage to multiple systems, leading to complications such as heart disease, cancer, and cerebrovascular disorders. Numerous epidemiological studies have shown that DM is closely associated with dementia and cognition dysfunction, with recent research focusing on the role of DM-mediated cerebrovascular damage in dementia. Despite the therapeutic benefits of antidiabetic agents for the treatment of DM-mediated cognitive dysfunction, most of these pharmaceutical agents are associated with various undesirable side-effects and their long-term benefits are therefore in doubt. Early evidence exists to support the use of traditional Chinese medicine (TCM) interventions, which tend to have minimal toxicity and side-effects. More importantly, these TCM interventions appear to offer significant effects in reducing DM-related complications beyond blood glucose control. However, more research is needed to further validate these claims and to explore their relevant mechanisms of action. The aims of this paper are (1) to provide an updated overview on the association between DM and cognitive dysfunction and (2) to review the scientific evidence underpinning the use of TCM interventions for the treatment and prevention of DM-induced cognitive dysfunction and dementia. PMID:26060494

  5. Cognitive impairment and memory dysfunction after a stroke diagnosis: a post-stroke memory assessment

    PubMed Central

    Al-Qazzaz, Noor Kamal; Ali, Sawal Hamid; Ahmad, Siti Anom; Islam, Shabiul; Mohamad, Khairiyah

    2014-01-01

    Cognitive impairment and memory dysfunction following stroke diagnosis are common symptoms that significantly affect the survivors’ quality of life. Stroke patients have a high potential to develop dementia within the first year of stroke onset. Currently, efforts are being exerted to assess stroke effects on the brain, particularly in the early stages. Numerous neuropsychological assessments are being used to evaluate and differentiate cognitive impairment and dementia following stroke. This article focuses on the role of available neuropsychological assessments in detection of dementia and memory loss after stroke. This review starts with stroke types and risk factors associated with dementia development, followed by a brief description of stroke diagnosis criteria and the effects of stroke on the brain that lead to cognitive impairment and end with memory loss. This review aims to combine available neuropsychological assessments to develop a post-stroke memory assessment (PSMA) scheme based on the most recognized and available studies. The proposed PSMA is expected to assess different types of memory functionalities that are related to different parts of the brain according to stroke location. An optimal therapeutic program that would help stroke patients enjoy additional years with higher quality of life is presented. PMID:25228808

  6. Resveratrol reversed chronic restraint stress-induced impaired cognitive function in rats.

    PubMed

    Zhang, Qian; Wang, Xueer; Bai, Xuemei; Xie, Yunkai; Zhang, Tiantian; Bo, Shishi; Chen, Xiaoyang

    2017-08-01

    Chronic stress occurs in everyday life, and often results in memory impairments and depressive symptoms. Resveratrol is a natural polyphenol that possesses numerous biological properties, including potent antidepressant‑like effects. The present study aimed to examine the effects of resveratrol treatment on chronic restraint stress (CRS)‑induced cognitive impairment and to explore the underlying molecular mechanisms. Male Wistar rats were exposed to CRS for 21 days in order to induce depressive‑like behavior. The results demonstrated that CRS (6 h/day, 21 days) was able to induce cognitive deficits in rats, as evidenced by Morris water maze and novel object recognition tests. In addition, CRS exposure significantly decreased the mRNA and protein expression levels of hippocampal brain‑derived neurotrophic factor (BDNF) in the rats. Conversely, chronic treatment with resveratrol (80 mg/kg, i.p.; 21 days) significantly prevented the behavioral and biochemical alterations induced by CRS. The effects of resveratrol were nearly identical to those observed with fluoxetine treatment. In conclusion, the present study demonstrated that resveratrol may be a potential therapeutic agent for the treatment of chronic stress‑induced cognitive impairments, and its underlying molecular mechanism may be associated with the increased levels of hippocampal BDNF.

  7. Mild cognitive impairment in different functional domains and incident Alzheimer's disease

    PubMed Central

    Aggarwal, N; Wilson, R; Beck, T; Bienias, J; Bennett, D

    2005-01-01

    Background: Little is known about factors that predict transition from mild cognitive impairment to Alzheimer's disease (AD). Objective: To examine the relation of impairment in different cognitive systems to risk of developing AD in persons with mild cognitive impairment. Methods: Participants are 218 older Catholic clergy members from the Religious Orders Study. At baseline, they met criteria for mild cognitive impairment based on a uniform clinical evaluation that included detailed cognitive testing. Evaluations were repeated annually for up to 10 years. Analyses were controlled for age, sex, and education. Results: Eighty two persons (37.6%) developed AD. In separate analyses, episodic memory, semantic memory, working memory, and perceptual speed, but not visuospatial ability, were associated with risk of AD, but when analysed together only episodic memory and perceptual speed were associated with AD incidence, with the effect for episodic memory especially strong. Overall, those with impaired episodic memory were more than twice as likely to develop AD as those with impairment in other cognitive domains (relative risk (RR) = 2.45; 95% confidence interval (CI): 1.53 to 3.92), and they experienced more rapid cognitive decline. Lower episodic memory performance was associated with increased risk of AD throughout the observation period, whereas impairment in other cognitive domains was primarily associated with risk during the following year but not thereafter. Conclusion: Among persons with mild cognitive impairment, episodic memory impairment is associated with a substantial and persistent elevation in risk of developing AD compared to impairment in other cognitive systems. PMID:16227534

  8. Depression and Cognitive Function in Mild Cognitive Impairment: A 1-Year Follow-Up Study.

    PubMed

    Yoon, Seoyoung; Shin, Cheolmin; Han, Changsu

    2017-09-01

    The coexistence of depression with mild cognitive impairment (MCI) seems to increase the risk of dementia. However, the explanations of that relationship have been inconsistent. We investigated cognitive profiles in patients with MCI with and without depression and whether changes in depression symptoms affect cognition longitudinally. For the study, 161 patients with MCI were divided into a depressed group (D+) and a nondepressed group (D-). After 1 year, we redivided the original D- group into D- and newly developed depression (Dd) groups and the D+ group into improved depression (Di) and nonimproved depression (Dn) groups. Neuropsychological tests assessing depression and cognitive domains were performed at baseline and follow-up. When age-adjusted, the D+ group showed significantly poorer performance in general cognition and some subtests regarding memory, executive function, and attention. At the 1-year follow-up, changes in the calculation test ( P = .005) and Controlled Oral Word Test (COWAT; P = .048) were significantly different between groups. Only the Di group showed significant improvement in calculation. The Dn group showed significant decrement in COWAT that was significantly different from that of the Di group, which showed no significant change. Patients with depression having MCI showed poorer cognitive function than nondepressed patients with MCI in some cognitive domains. Improvement in depression was related to improvement or prevention of decline in cognitive measures.

  9. Effects of Aerobic Exercise on Mild Cognitive Impairment

    PubMed Central

    Baker, Laura D.; Frank, Laura L.; Foster-Schubert, Karen; Green, Pattie S.; Wilkinson, Charles W.; McTiernan, Anne; Plymate, Stephen R.; Fishel, Mark A.; Stennis Watson, G.; Cholerton, Brenna A.; Duncan, Glen E.; Mehta, Pankaj D.; Craft, Suzanne

    2011-01-01

    Objectives To examine the effects of aerobic exercise on cognition and other biomarkers associated with Alzheimer disease pathology for older adults with mild cognitive impairment, and assess the role of sex as a predictor of response. Design Six-month, randomized, controlled, clinical trial. Setting Veterans Affairs Puget Sound Health Care System clinical research unit. Participants Thirty-three adults (17 women) with amnestic mild cognitive impairment ranging in age from 55 to 85 years (mean age,70 years). Intervention Participants were randomized either to a high-intensity aerobic exercise or stretching control group. The aerobic group exercised under the supervision of a fitness trainer at 75% to 85% of heart rate reserve for 45 to 60 min/d, 4 d/wk for 6 months. The control group carried out supervised stretching activities according to the same schedule but maintained their heart rate at or below 50% of their heart rate reserve. Before and after the study, glucometabolic and treadmill tests were performed and fat distribution was assessed using dual-energy x-ray absorptiometry. At baseline, month 3, and month 6, blood was collected for assay and cognitive tests were administered. Main Outcome Measures Performance measures on Symbol-Digit Modalities, Verbal Fluency, Stroop, Trails B, Task Switching, Story Recall, and List Learning. Fasting plasma levels of insulin, cortisol, brain-derived neurotrophic factor, insulinlike growth factor-I, and β-amyloids 40 and 42. Results Six months of high-intensity aerobic exercise had sex-specific effects on cognition, glucose metabolism, and hypothalamic-pituitary-adrenal axis and trophic activity despite comparable gains in cardiorespiratory fitness and body fat reduction. For women, aerobic exercise improved performance on multiple tests of executive function, increased glucose disposal during the metabolic clamp, and reduced fasting plasma levels of insulin, cortisol, and brain-derived neurotrophic factor. For men

  10. Chronic renal dysfunction and anaemia are associated with cognitive impairment in older patients with heart failure.

    PubMed

    Pulignano, Giovanni; Del Sindaco, Donatella; Di Lenarda, Andrea; Tinti, Maria Denitza; Tarantini, Luigi; Cioffi, Giovanni; Tolone, Stefano; Pero, Gaetano; Minardi, Giovanni

    2014-06-01

    Cognitive impairment, anaemia and chronic kidney disease (CKD) are associated with mortality and disability in chronic heart failure patients. We hypothesized that anaemia and CKD are independent predictors of cognitive impairment in older patients with heart failure. One hundred and ninety community-living elderly patients aged at least 70 years, treated with optimized therapy for heart failure in stable clinical conditions, were prospectively studied. They underwent clinical and multidimensional assessment. Cognitive status was assessed by the Mini Mental State Examination. Cognitive impairment was defined as the Mini Mental State Examination score adjusted by age and educational level below 24. CKD was defined as the Cockcroft-Gault glomerular filtration rate below 60  ml/min and anaemia as haemoglobin below 12  g/dl. Cognitive impairment was diagnosed in 38.9% of patients, CKD in 85.7% and anaemia in 42.6%. Age, female sex, BMI, education less than 5 years, depressive symptoms, anaemia, CKD, disability and worse quality of life were significantly associated with cognitive impairment. Cognitive impairment involved primarily global cognitive deficit, memory, mental speed, attention, calculation and language. A significant relationship between haemoglobin levels and cognitive impairment was found, with the range of 15-16.5  g/dl having the lower prevalence of cognitive impairment (19.4%). At multivariate analysis, advanced age, low education level, anaemia and CKD were independently associated with cognitive impairment. Cox analysis showed that cognitive impairment was an independent predictor of hospitalization for worsening heart failure alone and combined with all-cause death. Cognitive impairment is common in elderly heart failure patients and is independently associated with anaemia and renal dysfunction. Further studies are needed to assess whether optimal treatment of anaemia and CKD may prevent the development of cognitive impairment in heart failure

  11. Postnatal irradiation-induced hippocampal neuropathology, cognitive impairment and aging.

    PubMed

    Tang, Feng Ru; Loke, Weng Keong; Khoo, Boo Cheong

    2017-04-01

    Irradiation of the brain in early human life may set abnormal developmental events into motion that last a lifetime, leading to a poor quality of life for affected individuals. While the effect of irradiation at different early developmental stages on the late human life has not been investigated systematically, animal experimental studies suggest that acute postnatal irradiation with ⩾0.1Gy may significantly reduce neurogenesis in the dentate gyrus and endotheliogenesis in cerebral vessels and induce cognitive impairment and aging. Fractionated irradiation also reduces neurogenesis. Furthermore, irradiation induces hippocampal neuronal loss in CA1 and CA3 areas, neuroinflammation and reduces gliogenesis. The hippocampal neurovascular niche and the total number of microvessels are also changed after radiation exposures. Each or combination of these pathological changes may cause cognitive impairment and aging. Interestingly, acute irradiation of aged brain with a certain amount of radiation has also been reported to induce brain hormesis or neurogenesis. At molecular levels, inflammatory cytokines, chemokines, neural growth factors, neurotransmitters, their receptors and signal transduction systems, reactive oxygen species are involved in radiation-induced adverse effect on brain development and functions. Further study at different omics levels after low dose/dose rate irradiation may not only unravel the mechanisms of radiation-induced adverse brain effect or hormesis, but also provide clues for detection or diagnosis of radiation exposure and for therapeutic approaches to effectively prevent radiation-induced cognitive impairment and aging. Investigation focusing on radiation-induced changes of critical brain development events may reveal many previously unknown adverse effects.

  12. Telmisartan attenuates cognitive impairment caused by chronic stress in rats.

    PubMed

    Wincewicz, Dominik; Braszko, Jan J

    2014-06-01

    The potential effect of chronic treatment with telmisartan, an angiotensin type 1 receptor blocker (ARB) and partial agonist of peroxisome proliferator--activated receptor γ (PPARγ), on stress-related disorders is a matter of considerable interest. The existing data suggest that angiotensin II (Ang II) plays a major role in exaggerated sympathetic and hormonal response to stress. Enhanced formation of Ang II and increased AT1 receptor activity is associated with devastating impact of stress on central nervous system, which may trigger many psychiatric disorders such as depression, schizophrenia or post-traumatic stress disorder. Some of the anti-stress effects of ARBs have already been proven but these on the stress-induced cognitive impairment were examined only for candesartan. In this study, we tested a hypothesis that blockade of stress response by another ARB telmisartan alleviates the negative effect of prolonged restraint stress on cognitive functions of male Wistar rats. The preventive action of long-lasting treatment with telmisartan (1mg/kg body weight) against impairment caused by chronic stress (2h daily for 21 days) on recall was evaluated in a passive avoidance (PA) situation and object recognition test (ORT). Locomotor activity and anxiety behavior were tested respectively, in an open field and an elevated plus-maze. The results of this study indicate that telmisartan diminishes deleterious effects of chronic restraint stress on memory in a statistically significant manner (p<0.01) in both, PA situation and ORT. It appears that telmisartan may constitute a new therapeutic option in a stress-related cognitive impairment. Copyright © 2014 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  13. Oculomotor Reflexes as a Test of Visual Dysfunctions in Cognitively Impaired Observers

    DTIC Science & Technology

    2013-09-01

    reflexes provide a simple and robust method to study vision in passive/immature/ impaired observers. For example, oculomotor reflexes are widely used to...dysfunctions in cognitively impaired observers PRINCIPAL INVESTIGATOR: YuryPetrov,Ph.D...September 2013 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Oculomotor reflexes as a test of visual dysfunctions in cognitively impaired observers 5b

  14. A behavioral rehabilitation intervention for amnestic Mild Cognitive Impairment

    PubMed Central

    Greenaway, Melanie C.; Hanna, Sherrie M.; Lepore, Susan W.; Smith, Glenn E.

    2010-01-01

    Individuals with amnestic Mild Cognitive Impairment (MCI) currently have few treatment options for combating their memory loss. The Memory Support System (MSS) is a calendar and organization system with accompanying 6-week curriculum designed for individuals with progressive memory impairment. Ability to learn the MSS and its utility were assessed in 20 participants. Participants were significantly more likely to successfully use the calendar system after training. Ninety-five percent were compliant with the MSS at training completion, and 89% continued to be compliant at follow-up. Outcome measures revealed a medium effect size for improvement in functional ability. Subjects further reported improved independence, self-confidence, and mood. This initial examination of the MSS suggests that with appropriate training, individuals with amnestic MCI can and will use a memory notebook system to help compensate for memory loss. These results are encouraging that the MSS may help with the symptoms of memory decline in MCI. PMID:18955724

  15. Nutraceuticals in cognitive impairment and Alzheimer’s disease

    PubMed Central

    Mecocci, P.; Tinarelli, C.; Schulz, R. J.; Polidori, M. C.

    2014-01-01

    Several chemical substances belonging to classes of natural dietary origin display protective properties against some age-related diseases including neurodegenerative ones, particularly Alzheimer’s disease (AD). These compounds, known as nutraceuticals, differ structurally, act therefore at different biochemical and metabolic levels and have shown different types of neuroprotective properties. The aim of this review is to summarize data from observational studies, clinical trials, and randomized clinical trials (RCTs) in humans on the effects of selected nutraceuticals against age-related cognitive impairment and dementia. We report results from studies on flavonoids, some vitamins and other natural substances that have been studied in AD and that might be beneficial for the maintenance of a good cognitive performance. Due to the substantial lack of high-level evidence studies there is no possibility for recommendation of nutraceuticals in dementia-related therapeutic guidelines. Nevertheless, the strong potential for their neuroprotective action warrants further studies in the field. PMID:25002849

  16. Cognitive impairment in patients with AIDS – prevalence and severity

    PubMed Central

    Watkins, Crystal C; Treisman, Glenn J

    2015-01-01

    The advent of highly active antiretroviral therapy has prolonged the life expectancy of HIV patients and decreased the number of adults who progress to AIDS and HIV-associated dementia. However, neurocognitive deficits remain a pronounced consequence of HIV/AIDS. HIV-1 infection targets the central nervous system in subcortical brain areas and leads to high rates of delirium, depression, opportunistic central nervous system infections, and dementia. Long-term HIV replication in the brain occurs in astrocytes and microglia, allowing the virus to hide from antiviral medication and later compromise neuronal function. The associated cognitive disturbance is linked to both viral activity and inflammatory and other mediators from these immune cells that lead to the damage associated with HIV-associated neurocognitive disorders, a general term given for these disturbances. We review the severity and prevalence of the neuropsychiatric complications of HIV including delirium, neurobehavioral impairments (depression), minor cognitive-motor dysfunction, and HIV-associated dementia. PMID:25678819

  17. Profiles of Mild Cognitive Impairment (MCI) in the Elderly.

    PubMed

    Peraita, Herminia; Chacón, José; Díaz-Mardomingo, Carmen; Martínez-Arias, Rosario

    2015-11-20

    We applied latent class analysis (LCA) to a set of neuropsychological data with the aim of corroborating the three cognitive profiles of mild cognitive impairment (MCI) described in the literature, namely: healthy, amnestic, non-amnestic, and multidomain. The ultimate purpose of the LCA was to try to find the underlying classification of MCI and related pathologies by means of the participants' response patterns, rather than on more classical psychometric criteria, such as the standard deviation of the mean. We computed 547 neuropsychological assessments derived from 223 participants who were assessed annually for three consecutive years. The battery included tests of memory, language, executive function, and praxis. The results obtained by means of LCA, with a four-group solution and using the 40th percentile as the criterion, confirm prior classifications obtained with more questionable psychometric criteria, while providing longitudinal data on the course of MCI and the stability of group assignment over time.

  18. Coping with cognitive impairment and dementia: Rural caregivers' perspectives.

    PubMed

    Branger, Camille; Burton, Rachel; O'Connell, Megan E; Stewart, Norma; Morgan, Debra

    2016-07-01

    Caregiving in a rural context is unique, but the experience of rural caregivers is understudied. This paper describes how rural caregivers cope with caring for a loved one diagnosed with mild cognitive impairment or dementia using qualitative description to generate a low-inference summary of a response to an open-ended question. This approach allowed these rural caregivers to describe their positive experiences in addition to the more commonly explored caregiver experiences related to stress. Analyses of coping revealed use of social support, engaging in relaxing and physical activity, and cognitive reframing. In addition, caregivers reported strong faith and religiosity, and to a lesser frequency behavioral changes, checking in with the person with dementia via telephone, and joint activity. Predominantly, these methods reflect approach-based strategies. The current data suggest that these caregivers manage well and adopt adaptive coping strategies to meet the demands of the caregiving role. © The Author(s) 2014.

  19. Long-Term Cognitive Impairment in Kleine-Levin Syndrome.

    PubMed

    Uguccioni, Ginevra; Lavault, Sophie; Chaumereuil, Charlotte; Golmard, Jean-Louis; Gagnon, Jean-François; Arnulf, Isabelle

    2016-02-01

    In Kleine-Levin syndrome (KLS), episodes of hypersomnia, cognitive, and behavioral disturbances alternate with asymptomatic periods. Because 50% of patients report decreased academic performances, we evaluated their cognitive status during asymptomatic periods, determinants of deficits, and changes during follow-up. The cognitive assessment during asymptomatic periods in all consecutive patients with typical KLS and healthy controls included the non-verbal intelligence quotient (Raven Progressive Matrices), the Trail Making Test, the Stroop Color-Word Test, the Wechsler Memory Test, verbal fluencies, the Free and Cued Learning Memory Test, and the Rey-Osterreith Complex Figure. Cognitive status was reevaluated after 0.5 to 2 y in 44 patients. At baseline, compared with the 42 controls, the 122 patients with KLS exhibited lower non-verbal intelligence quotient, speed of processing, attention, and reduced retrieval strategies in episodic memory. Higher episode frequency, shorter episode duration, shorter time since last episode, deeper sleep, and megaphagia during episodes predicted impaired memory. The visuoconstructional abilities and non-verbal memory were intact. After a mean follow-up of 1.7 ± 1.0 y, the episode frequency decreased from 4.6 ± 4.8 to 1.7 ± 1.9/y. The logical reasoning and attention improved, the processing speed remained low, and the retrieval strategies in verbal memory further worsened. In this field study, one-third of patients with KLS have long-term cognitive deficits affecting retrieval and processing speed. Cognitive function should be systematically tested in patients with KLS, which appears important to help patients in their academic studies. © 2016 Associated Professional Sleep Societies, LLC.

  20. Contextual Social Cognition Impairments in Schizophrenia and Bipolar Disorder

    PubMed Central

    Villarin, Lilian; Theil, Donna; Gonzalez-Gadea, María Luz; Gomez, Pedro; Mosquera, Marcela; Huepe, David; Strejilevich, Sergio; Vigliecca, Nora Silvana; Matthäus, Franziska; Decety, Jean; Manes, Facundo; Ibañez, Agustín M.

    2013-01-01

    Background The ability to integrate contextual information with social cues to generate social meaning is a key aspect of social cognition. It is widely accepted that patients with schizophrenia and bipolar disorders have deficits in social cognition; however, previous studies on these disorders did not use tasks that replicate everyday situations. Methodology/Principal Findings This study evaluates the performance of patients with schizophrenia and bipolar disorders on social cognition tasks (emotional processing, empathy, and social norms knowledge) that incorporate different levels of contextual dependence and involvement of real-life scenarios. Furthermore, we explored the association between social cognition measures, clinical symptoms and executive functions. Using a logistic regression analysis, we explored whether the involvement of more basic skills in emotional processing predicted performance on empathy tasks. The results showed that both patient groups exhibited deficits in social cognition tasks with greater context sensitivity and involvement of real-life scenarios. These deficits were more severe in schizophrenic than in bipolar patients. Patients did not differ from controls in tasks involving explicit knowledge. Moreover, schizophrenic patients’ depression levels were negatively correlated with performance on empathy tasks. Conclusions/Significance Overall performance on emotion recognition predicted performance on intentionality attribution during the more ambiguous situations of the empathy task. These results suggest that social cognition deficits could be related to a general impairment in the capacity to implicitly integrate contextual cues. Important implications for the assessment and treatment of individuals with schizophrenia and bipolar disorders, as well as for neurocognitive models of these pathologies are discussed. PMID:23520477

  1. Strictly Lobar Cerebral Microbleeds Are Associated With Cognitive Impairment.

    PubMed

    Chung, Chih-Ping; Chou, Kun-Hsien; Chen, Wei-Ta; Liu, Li-Kuo; Lee, Wei-Ju; Chen, Liang-Kung; Lin, Ching-Po; Wang, Pei-Ning

    2016-10-01

    Different distributions of cerebral microbleeds (CMBs) are associated with distinct pathological mechanisms. Lobar CMBs are thought to be related to cerebral amyloid angiopathy, whereas deep or infratentorial CMBs are related to hypertensive vasculopathy. The present study aimed to evaluate the effects of CMBs and their locations on a variety of cognitive domains. Study subjects were selected from the community-based I-Lan Longitudinal Aging Study. We assessed cognitive domains, including verbal memory, language, visuospatial executive function, and verbal executive function. CMBs were evaluated using 3T susceptibility-weighted magnetic resonance imaging. We studied 959 subjects (mean±SD, 62.5±8.6 years; 425 [44.3%] men). CMBs were found in 14.2% of the population. We classified subjects with CMBs into 2 different groups based on the locations of their CMBs: (1) deep or infratentorial (85 subjects, 8.8% of population) and (2) strictly lobar (49, 5.1%). Multivariate linear analysis showed that strictly lobar CMBs were significantly associated with deficits in global cognitive function (Mini-Mental State Examination) and visuospatial executive function, as determined by the copy test of the Taylor complex figure test and the clock drawing test. We adjusted our results for age, sex, years of education, cardiovascular risk factors, and other markers of cerebral small vessel disease, lacunes, and white matter hyperintensity. Deep or infratentorial CMBs were not associated with changes in cognitive function in our population. Strictly lobar, but not deep or infratentorial, CMBs are associated with changes in cognitive function, especially in visuospatial executive functions. Cerebral amyloid angiopathy may be the underlying pathology associated with CMB-related cognitive impairment. © 2016 American Heart Association, Inc.

  2. Early risk predictors for impaired numerical skills in 5-year-old children born before 32 weeks of gestation.

    PubMed

    Kiechl-Kohlendorfer, Ursula; Ralser, Elisabeth; Pupp Peglow, Ulrike; Pehboeck-Walser, Nicola; Fussenegger, Barbara

    2013-01-01

    To unravel risk predictors for impaired numerical skills at 5 years of age in a population-based cohort of very preterm infants. Between January 2003 and August 2006, we prospectively enrolled all infants born in Tyrol with <32 weeks of gestation. A total of 161 of 223 preterm infants (participation rate 72.2%) had a detailed examination at 5 years of age including cognitive assessment (Hannover-Wechsler Intelligence Test for preschool children, third edition (HAWIVA-III) or Snijders-Oomen Nonverbal Intelligence Test (SON-R)). In 135 children, numerical abilities were assessed with the dyscalculia test TEDI-MATH. The association between pre- and postnatal factors and impaired numerical skills was analyzed by means of logistic regression analysis. Dyscalculia test showed delayed numerical skills (TEDI-MATH Sum T-score <40) in 27 of 135 children tested (20.0%). In half of the children tested, delayed numerical abilities were related to lower IQ scores. Smoking in pregnancy, intracerebral haemorrhage and chronic lung disease were predictive of delayed numerical skills at 5 years of age in the multivariate analysis. This study identified risk predictors for impaired numerical skills in preterm infants. Our data support the role of both pre- and perinatal factors in the evolution of mathematical deficits. ©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.

  3. Naturalistic measures of prospective memory in amnestic mild cognitive impairment.

    PubMed

    Delprado, Jacinta; Kinsella, Glynda; Ong, Ben; Pike, Kerryn

    2013-06-01

    Several studies have now reported that individuals with amnestic mild cognitive impairment (aMCI) are impaired on laboratory-based measures of prospective memory (PM). However, the age-PM paradox has revealed that impairment observed in the laboratory does not necessarily reflect functioning in day-to-day life. The current study examined naturalistic measures of PM by comparing participants with aMCI to healthy older adults on experimenter-introduced PM tasks (Experiment 1) and on participants' own, self-generated PM tasks (Experiment 2). Individuals with aMCI were found to be globally impaired on each of the naturalistic measures of PM Strategy use was found to be a distinguishing feature between the two groups with healthy older adults using more written strategies, whereas individuals with aMCI relied more on another person providing a reminder. Also of note was that both groups only used strategies around half the time for their own PM tasks. Findings are discussed in terms of implications for interventions and the day-to-day functioning of individuals with aMCI, a population that is struggling to maintain independence in the community. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  4. Dysexecutive Functioning in Mild Cognitive Impairment: Derailment in Temporal Gradients

    PubMed Central

    Eppig, Joel; Wambach, Denene; Nieves, Christine; Price, Catherine C.; Lamar, Melissa; Delano-Wood, Lisa; Giovannetti, Tania; Bettcher, Brianne M.; Penney, Dana L.; Swenson, Rod; Lippa, Carol; Kabasakalian, Anahid; Bondi, Mark W.; Libon, David J.

    2012-01-01

    Libon et al. (2010) provided evidence for three statistically determined clusters of patients with mild cognitive impairment (MCI): amnesic (aMCI), dysexecutive (dMCI), and mixed (mxMCI). The current study further examined dysexecutive impairment in MCI using the framework of Fuster's (1997) derailed temporal gradients, that is, declining performance on executive tests over time or test epoch. Temporal gradients were operationally defined by calculating the slope of aggregate letter fluency output across 15-s epochs and accuracy indices for initial, middle, and latter triads from the Wechsler Memory Scale-Mental Control subtest (Boston Revision). For letter fluency, slope was steeper for dMCI compared to aMCI and NC groups. Between-group Mental Control analyses for triad 1 revealed worse dMCI performance than NC participants. On triad 2, dMCI scored lower than aMCI and NCs; on triad 3, mxMCI performed worse versus NCs. Within-group Mental Control analyses yielded equal performance across all triads for aMCI and NC participants. mxMCI scored lower on triad 1 compared to triads 2 and 3. dMCI participants also performed worse on triad 1 compared to triads 2 and 3, but scored higher on triad 3 versus triad 2. These data suggest impaired temporal gradients may provide a useful heuristic for understanding dysexecutive impairment in MCI. PMID:22014116

  5. Vascular contributions to cognitive impairment and dementia including Alzheimer's disease.

    PubMed

    Snyder, Heather M; Corriveau, Roderick A; Craft, Suzanne; Faber, James E; Greenberg, Steven M; Knopman, David; Lamb, Bruce T; Montine, Thomas J; Nedergaard, Maiken; Schaffer, Chris B; Schneider, Julie A; Wellington, Cheryl; Wilcock, Donna M; Zipfel, Gregory J; Zlokovic, Berislav; Bain, Lisa J; Bosetti, Francesca; Galis, Zorina S; Koroshetz, Walter; Carrillo, Maria C

    2015-06-01

    Scientific evidence continues to demonstrate the linkage of vascular contributions to cognitive impairment and dementia such as Alzheimer's disease. In December, 2013, the Alzheimer's Association, with scientific input from the National Institute of Neurological Disorders and Stroke and the National Heart, Lung and Blood Institute from the National Institutes of Health, convened scientific experts to discuss the research gaps in our understanding of how vascular factors contribute to Alzheimer's disease and related dementia. This manuscript summarizes the meeting and the resultant discussion, including an outline of next steps needed to move this area of research forward. Copyright © 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  6. CSF cortisol in Alzheimer's disease and mild cognitive impairment.

    PubMed

    Popp, Julius; Schaper, Karsten; Kölsch, Heike; Cvetanovska, Gabriela; Rommel, Fatima; Klingmüller, Dietrich; Dodel, Richard; Wüllner, Ullrich; Jessen, Frank

    2009-03-01

    Hypercortisolaemia occurs in Alzheimer's disease (AD) and may be involved in the AD related neurodegenerative process. In order to determine whether brain structures are exposed to high cortisol concentrations early in AD, we measured cerebrospinal fluid (CSF) cortisol in 66 subjects with AD, 33 subjects with mild cognitive impairment (MCI) and 34 control subjects. CSF cortisol concentrations were higher in AD subjects compared to controls (p<0.001) and to MCI subjects (p=0.002). There was no significant increase of cortisol in MCI subjects compared with controls suggesting that the increase of CSF cortisol is not an early event in the course of AD.

  7. Driving in mild cognitive impairment: The role of depressive symptoms.

    PubMed

    Beratis, Ion N; Andronas, Nikos; Kontaxopoulou, Dionysia; Fragkiadaki, Stella; Pavlou, Dimosthenis; Papatriantafyllou, John; Economou, Alexandra; Yannis, George; Papageorgiou, Sokratis G

    2017-07-04

    Previous studies indicate a negative association between depression and driving fitness in the general population. Our goal was to cover a gap in the literature and to explore the link between depressive symptoms and driving behavior in individuals with mild cognitive impairment (MCI) through the use of a driving simulator experiment. Twenty-four individuals with MCI (mean age = 67.42, SD = 7.13) and 23 cognitively healthy individuals (mean age = 65.13, SD = 7.21) were introduced in the study. A valid driving license and regular car use served as main inclusion criteria. Data collection included a neurological/neuropsychological assessment and a driving simulator evaluation. Depressive symptomatology was assessed with the Patient Health Questionnaire (PHQ-9). Significant interaction effects indicating a greater negative impact of depressive symptoms in drivers with MCI than in cognitively healthy drivers were observed in the case of various driving indexes, namely, average speed, accident risk, side bar hits, headway distance, headway distance variation, and lateral position variation. The associations between depressive symptoms and driving behavior remained significant after controlling for daytime sleepiness and cognition. Depressive symptoms could be a factor explaining why certain patients with MCI present altered driving skills. Therefore, interventions for treating the depressive symptoms of individuals with MCI could prove to be beneficial regarding their driving performance.

  8. New strategies for Alzheimer disease and cognitive impairment

    PubMed Central

    Chong, Zhao Zhong; Hou, Jinling; Shang, Yan Chen

    2009-01-01

    Approximately five million people suffer with Alzheimer disease (AD) and more than twenty-four million people are diagnosed with AD, pre-senile dementia, and other disorders of cognitive loss worldwide. Furthermore, the annual cost per patient with AD can approach $200,000 with an annual population aggregate cost of $100 billion. Yet, complete therapeutic prevention or reversal of neurovascular injury during AD and cognitive loss is not achievable despite the current understanding of the cellular pathways that modulate nervous system injury during these disorders. As a result, identification of novel therapeutic targets for the treatment of neurovascular injury would be extremely beneficial to reduce or eliminate disability from diseases that lead to cognitive loss or impairment. Here we describe the capacity of intrinsic cellular mechanisms for the novel pathways of erythropoietin and forkhead transcription factors that may offer not only new strategies for disorders such as AD and cognitive loss, but also function as biomarkers for disease onset and progression. PMID:20716915

  9. Cortical asymmetries in normal, mild cognitive impairment, and Alzheimer's disease.

    PubMed

    Kim, Jong Hun; Lee, Jong Weon; Kim, Geon Ha; Roh, Jee Hoon; Kim, Min-Jeong; Seo, Sang Won; Kim, Sung Tae; Jeon, Seun; Lee, Jong-Min; Heilman, Kenneth M; Na, Duk L

    2012-09-01

    There are functional and structural neocortical hemispheric asymmetries in people with normal cognition. These asymmetries may be altered in patients with Alzheimer's disease (AD) because there is a loss of neuronal connectivity in the heteromodal cortex. The purpose of this study is to test the hypothesis that individuals with amnestic mild cognitive impairment (aMCI), mild AD, and moderate to severe AD have progressive reductions in thickness asymmetries of the heteromodal neocortex. Right-handed elderly volunteers including normal cognition (NC), aMCI, and AD underwent 3-D volume imaging for cortical thickness. Although the cortical asymmetry pattern observed in normal cognition brains was generally maintained in aMCI and AD, there was a progressive decrease in the degree of asymmetry, especially in the inferior parietal lobule. A reduction of neocortical asymmetries may be a characteristic sign that occurs in patients with AD. Future studies are needed to evaluate whether this loss is specific to AD and if measurements of asymmetry can be used as diagnostic markers and for monitoring disease progression.

  10. Multimodal MRI classification in vascular mild cognitive impairment.

    PubMed

    Diciotti, Stefano; Ciulli, Stefano; Ginestroni, Andrea; Salvadori, Emilia; Poggesi, Anna; Pantoni, Leonardo; Inzitari, Domenico; Mascalchi, Mario; Toschi, Nicola

    2015-08-01

    Vascular mild cognitive impairment (VMCI) is a disorder in which multimodal MRI can add significant value by combining diffusion tensor imaging (DTI) with brain morphometry. In this study we implemented and compared machine learning techniques for multimodal classification between 58 VMCI patients and 29 healthy subjects as well as for discrimination (within the VMCI group) between patients with different cognitive performances. For each subject, a cortical feature vector was constructed based on cortical parcellation and cortical and subcortical volumetric segmentation and a DTI feature vector was formed by combining descriptive statistical metrics related to the distribution of DTI invariants within white matter. We employed both a sequential minimal optimization and a functional tree classifier, using feature selection and 10-fold cross-validation, and compared their performances in monomodal and multimodal classification for both classification problems (healthy subjects vs VMCI and prediction of cognitive performance). While monomodal classification resulted in satisfactory performance in most cases, turning from monomodal to multimodal classification resulted in an improvement of the performance in the discrimination between VMCI patients with low cognitive performance and healthy subjects by up to 10% in sensitivity (leaving specificity unchanged). We therefore are able to confirm the usefulness of machine learning techniques in discriminating diseased states based on neuroimaging data.

  11. A systematic review of treatments for Mild Cognitive Impairment

    PubMed Central

    Cooper, Claudia; Li, Ryan; Lyketsos, Constantine; Livingston, Gill

    2014-01-01

    Background More people are presenting with mild cognitive impairment (MCI), frequently a precursor to dementia but we do not know how to reduce deterioration. Aims To systematically review Randomised Controlled Trials (RCTs) evaluating effects of any intervention for MCI on cognitive, neuropsychiatric, functional, global outcomes, life quality, or incident dementia. Methods We reviewed the 41 studies fitting predetermined criteria, assessed validity using a checklist, calculated standardised outcomes, and prioritised primary outcome findings in placebo-controlled studies. Results The strongest evidence was that cholinesterase inhibitors did not reduce incident dementia. Cognition improved in single trials of: a heterogeneous psychological group intervention over 6 months; piribedil, a dopamine agonist over 3 months; and donepezil over 48 weeks. Nicotine improved attention over 6 months. There was equivocal evidence that Huannao Yicong improved cognition and social functioning. Conclusions There was no replicated evidence that any intervention was effective. Cholinesterase inhibitors and rofecoxib are ineffective in preventing dementia. Further good quality RCTs are necessary and preliminary evidence suggests these should include trials of psychological group interventions and piribedil. PMID:24085737

  12. Therapeutic application of melatonin in mild cognitive impairment

    PubMed Central

    Cardinali, Daniel P; Vigo, Daniel E; Olivar, Natividad; Vidal, María F; Furio, Analía M; Brusco, Luis I

    2012-01-01

    Mild cognitive impairment (MCI) is an etiologically heterogeneous syndrome defined by cognitive impairment in advance of dementia. We previously reported in a retrospective analysis that daily 3 - 9 mg of a fast-release melatonin preparation given p. o. at bedtime for up to 3 years significantly improved cognitive and emotional performance and daily sleep/wake cycle in MCI patients. In a follow up of that study we now report data from another series of 96 MCI outpatients, 61 of who had received daily 3 - 24 mg of a fast-release melatonin preparation p. o. at bedtime for 15 to 60 months. Melatonin was given in addition to the standard medication prescribed by the attending psychiatrist. Patients treated with melatonin exhibited significantly better performance in Mini–Mental State Examination and the cognitive subscale of the Alzheimer’s disease Assessment Scale. After application of a neuropsychological battery comprising a Mattis´ test, Digit-symbol test, Trail A and B tasks and the Rey´s verbal test, better performance was found in melatonin-treated patients for every parameter tested. Abnormally high Beck Depression Inventory scores decreased in melatonin-treated patients, concomitantly with the improvement in the quality of sleep and wakefulness. The comparison of the medication profile in both groups of MCI patients indicated that 9.8% in the melatonin group received benzodiazepines vs. 62.8% in the non-melatonin group. The results further support that melatonin can be a useful add-on drug for treating MCI in a clinic environment. PMID:23383398

  13. [Educational implications of the cognitive impairment in developmental dyslexia].

    PubMed

    Soriano Ferrer, M

    2004-02-01

    In this study we review the main theories put forward to account for developmental dyslexia, as well as the intervention procedures deriving from these theories that enjoy the most empirical support. Developmental dyslexia is a complex disorder that reflects cognitive impairment related to neurobiological anomalies, although researchers still do not agree on fundamental aspects regarding its aetiology. There are at present a number of different theories that can be grouped in two antagonistic lines of work. On the one hand, one of them considers that the exclusive and direct cause of dyslexia is a specific cognitive disorder. On the other hand, however, there are several theories that consider the impairments experienced by dyslexic patients to be part of a wide range of tasks and processes that are secondary to an underlying primary deficit. As a consequence of the progress made in the characterisation of dyslexia, an unprecedented effort has been made in recent decades in the development of intervention programmes and in the analysis of their effectiveness. Research into the explanation for dyslexia finds itself faced with the challenge of determining whether the different cognitive problems identified in dyslexic patients represent different cognitive routes towards the same dyslexic phenotype, whether they correspond to different types of dyslexia or whether they refer to the sum of the problems resulting from different comorbid conditions. Until this issue is resolved, as educators, we must carry out more comprehensive evaluations in order to determine the profile of the difficulties that are experienced in each particular case and to be able to tailor the interventions employed in this enigmatic problem.

  14. Cognitive stimulation of executive functions in mild cognitive impairment: specific efficacy and impact in memory.

    PubMed

    Moro, V; Condoleo, M T; Valbusa, V; Broggio, E; Moretto, G; Gambina, G

    2015-03-01

    Executive functions play an important role in the maintenance of autonomy in day-to-day activities. Nevertheless, there is little research into specific cognitive training for Mild Cognitive Impairment (MCI). We present the results of a program which aims to teach specific strategies and metacognitive abilities in order for patients to be able to carry out attentional and executive tasks. Two groups (A and B) were compared in a cross-over design. After the first evaluation, Group A (but not B) participated in a six month cognitive stimulation program. After a second assessment, only Group B received treatment and then a final evaluation was carried out on both groups. The results show that: i) both groups improved their performance as an effect of training; ii) improvements generalized to memory and general cognitive tasks; iii) in the interval without training, Group B's performance worsened and iv) Group A partially maintained their results over time.

  15. Count on dopamine: influences of COMT polymorphisms on numerical cognition

    PubMed Central

    Júlio-Costa, Annelise; Antunes, Andressa M.; Lopes-Silva, Júlia B.; Moreira, Bárbara C.; Vianna, Gabrielle S.; Wood, Guilherme; Carvalho, Maria R. S.; Haase, Vitor G.

    2013-01-01

    Catechol-O-methyltransferase (COMT) is an enzyme that is particularly important for the metabolism of dopamine. Functional polymorphisms of COMT have been implicated in working memory and numerical cognition. This is an exploratory study that aims at investigating associations between COMT polymorphisms, working memory, and numerical cognition. Elementary school children from 2th to 6th grades were divided into two groups according to their COMT val158met polymorphism [homozygous for valine allele (n = 61) vs. heterozygous plus methionine homozygous children or met+ group (n = 94)]. Both groups were matched for age and intelligence. Working memory was assessed through digit span and Corsi blocks. Symbolic numerical processing was assessed through transcoding and single-digit word problem tasks. Non-symbolic magnitude comparison and estimation tasks were used to assess number sense. Between-group differences were found in symbolic and non-symbolic numerical tasks, but not in working memory tasks. Children in the met+ group showed better performance in all numerical tasks while val homozygous children presented slower development of non-symbolic magnitude representations. These results suggest COMT-related dopaminergic modulation may be related not only to working memory, as found in previous studies, but also to the development of magnitude processing and magnitude representations. PMID:23966969

  16. Patterns of Cognitive Decline Prior to Dementia in Persons with Mild Cognitive Impairment

    PubMed Central

    Cloutier, Simon; Chertkow, Howard; Kergoat, Marie-Jeanne; Gauthier, Serge; Belleville, Sylvie

    2015-01-01

    Abstract Only a limited number of studies have investigated the decline of discrete cognitive domains as individuals progress from mild cognitive impairment (MCI) to dementia. Thus, the goal of this longitudinal study was to evaluate the cognitive changes underway during the years preceding a diagnosis of probable Alzheimer’s disease (AD), and to compare these changes to those found in MCI participants who do not progress to dementia. Participants were compared as a function of whether they later converted to AD (n = 47) or not (n = 74). Cognitive change was assessed prior to the conversion year, using that year as a starting point. A combination of polynomial regression analyses and mixed ANOVAs assessed 1) the trajectory of cognitive decline for each domain and 2) the differences between non-progressors and those who had converted to AD. The different cognitive domains demonstrated very different patterns of decline in the group of MCI progressors. A quadratic function, i.e., many years of stable performance followed by a rapid decline just prior to diagnosis, was observed for delayed recall, working memory, and spatial memory. In contrast, a gradual linear decline was observed for immediate recall, executive function, and visuo-spatial abilities. Finally, language in progressors was impaired on all time periods relative to non-progressors, but there was no further change between the first assessments and conversion to AD. Individuals with MCI who progress to AD show abnormal cognition at least two years prior to their dementia diagnosis. The pattern of symptom change observed appears to depend upon the cognitive domain and thus, clinical studies should not assume similar rate of decline across domains. In contrast and, apart from verbal memory, the non-progressors present a performance similar to that of healthy older adults. PMID:26401770

  17. Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients.

    PubMed

    Krogseth, Maria; Watne, Leiv Otto; Juliebø, Vibeke; Skovlund, Eva; Engedal, Knut; Frihagen, Frede; Wyller, Torgeir Bruun

    2016-01-01

    Delirium is a risk factor for dementia in cognitively intact patients. Whether an episode of delirium accelerates cognitive decline in patients with known dementia, is less explored. This is a prospective follow-up study of 287 hip fracture patients with pre-fracture cognitive impairment. During the hospitalization, the patients were screened daily for delirium using the Confusion Assessment Method. Pre-fracture cognitive impairment was defined as a score of 3.44 or higher on the pre-fracture Informant Questionnaire on Cognitive Decline in the Elderly Short Form (IQCODE-SF). At follow-up after 4-6 months, the caregivers rated cognitive changes emerging after the fracture using the IQCODE-SF, and the patients were tested with the Mini Mental State Examination (MMSE). A sub-group of the patients had a pre-fracture MMSE score which was used to calculate the yearly decline on the MMSE in patients with and without delirium. 201 of the 287 patients developed delirium in the acute phase. In linear regression analysis, delirium was a significant and independent predictor of a more prominent cognitive decline at follow-up measured by the IQCODE-SF questionnaire (p=0.002). Among patients having a pre-fracture MMSE score, the patients developing delirium had a median (IQR) yearly decline of 2.4 points (1.1-3.9), compared to 1.0 points (0-1.9) in the group without delirium (p=0.001, Mann-Whitney test). Hip fracture patients with pre-fracture dementia run a higher risk of developing delirium. Delirium superimposed on dementia is a significant predictor of an accelerated further cognitive decline. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Early Functional Limitations in Cognitively Normal Older Adults Predict Diagnostic Conversion to Mild Cognitive Impairment.

    PubMed

    Farias, Sarah Tomaszewski; Lau, Karen; Harvey, Danielle; Denny, Katherine G; Barba, Cheyanne; Mefford, Anthony N

    2017-06-01

    To examine whether specific types of early functional limitations in cognitively normal older adults are associated with subsequent development of mild cognitive impairment (MCI), as well as the relative predictive value of self versus informant report in predicting diagnostic conversion to MCI. As a part of a longitudinal study design, participants underwent baseline and annual multidisciplinary clinical evaluations, including a physical and neurological examination, imaging, laboratory work, and neuropsychological testing. Data used in this study were collected as part of longitudinal research at the University of California, Davis Alzheimer's Disease Center. Individuals diagnosed as having normal cognition at study baseline who had an informant who could complete informant-based ratings and at least one follow-up visit (N = 324). Participants and informants each completed the Everyday Cognition Scale (ECog), an instrument designed to measure everyday function in six cognitively relevant domains. Self- and informant-reported functional limitations on the ECog were associated with significantly greater risk of diagnostic conversion to MCI (informant: hazard ratio (HR) = 2.0, 95% confidence interval (CI) = 1.3-3.2, P = .002), with self-report having a slightly higher hazard (HR = 2.3, 95% CI = 1.4-3.6, P < .001). When controlling for baseline cognitive abilities, the effect remained significant for self- and informant-reported functional limitations. Deficits in everyday memory and executive function domains were the strongest predictors of diagnostic conversion to MCI. Detection of early functional limitations may be clinically useful in assessing the future risk of developing cognitive impairment in cognitively normal older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  19. Cognitive Effects of Intentional Weight Loss in Elderly Obese Individuals With Mild Cognitive Impairment.

    PubMed

    Horie, Nidia Celeste; Serrao, Valeria T; Simon, Sharon Sanz; Gascon, Maria Rita Polo; Dos Santos, Alessandra Xavier; Zambone, Maria Aquimara; Del Bigio de Freitas, Marta Merenciana; Cunha-Neto, Edecio; Marques, Emerson Leonildo; Halpern, Alfredo; de Melo, Maria Edna; Mancini, Marcio C; Cercato, Cintia

    2016-03-01

    Obesity in midlife is a risk factor for dementia, but it is unknown if caloric restriction-induced weight loss could prevent cognitive decline and therefore dementia in elderly patients with cognitive impairment. To evaluate the cognitive effect of intentional weight loss in obese elderly patients with mild cognitive impairment (MCI), considering the influence of age, apolipoprotein E (APOE) genotype, physical activity, biochemical markers, and diet. Single-center, prospective controlled trial. Academic medical center. Eighty obese patients with MCI, aged 60 or older (68.1 ± 4.9 y, body mass index [BMI] 35.5 ± 4.4 kg/m(2), 83.7% women, 26.3% APOE allele ϵ4 carriers). Random allocation to conventional medical care alone (n = 40) or together with nutritional counselling (n = 40) in group meetings aiming to promote weight loss through caloric restriction for 12 months. clinical data, body composition, neuropsychological tests (main outcome), serum biomarkers, APOE genotype, physical performance, dietary recalls. Seventy-five patients completed the follow-up. BMI, on average, decreased 1.7 ± 1.8 kg/m(2) (P = .021), and most of the cognitive tests improved, without difference between the groups. In analysis with linear generalized models, the BMI decrease was associated with improvements in verbal memory, verbal fluency, executive function, and global cognition, after adjustment for education, gender, physical activity, and baseline tests. This association was strongest in younger seniors (for memory and fluency) and in APOE allele ϵ4 carriers (for executive function). Changes in homeostasis model assessment-estimated insulin resistance, C-reactive protein, leptin and intake of energy, carbohydrates, and fats were associated with improvement in cognitive tests. Intentional weight loss through diet was associated with cognitive improvement in patients with MCI.

  20. Cognition Enhancing Activity of Sulforaphane Against Scopolamine Induced Cognitive Impairment in Zebra Fish (Danio rerio).

    PubMed

    Rajesh, Venugopalan; Ilanthalir, Sakthivel

    2016-10-01

    Several epidemiological studies have shown that consumption of large quantities of vegetables especially cruciferous vegetables (Broccoli and Brussels sprouts) can protect against chronic diseases. Sulforaphane, an isothiocynate found in cruciferous vegetables has been demonstrated to have neuroprotective effects in several experimental paradigms. This study was undertaken to examine the effect of sulforaphane on cognitive impairment in zebra fish model using a novel method of fear conditioning. Initially, the normal behaviour of zebra fishes was studied in light-dark tank for 10 min daily for 10 days. Fishes were then divided into seven groups of twelve in each. Group I served as normal, group II served as fear conditioned control, group III and group IV were sulforaphane (25 µM/L) and piracetam (200 mg/L) treated respectively. Group V served as scopolamine (400 µM/L) induced memory impairment fishes. Group VI and VII were sulforaphane (25 µM/L) and piracetam (200 mg/L) treated scopolamine induced memory impairment groups respectively. In normal behavioural analysis, fishes preferred to stay in dark compartment. The average number of entries into the dark and time spent in dark were significantly more. Fishes in group II to VII were individually subjected to fear conditioning passive avoidance task and evaluated for learned task memory. It was observed that the average number of entries into dark and time spent in dark were significantly decreased. After exposure to respective treatment fishes in group III to VII were subjected to cognitive evaluation. There was no significant difference in cognition of group III and IV fishes exposed to sulforaphane and piracetam alone respectively. Fishes exposed to scopolamine showed a significant cognitive impairment. Sulforaphane exposure prior to scopolamine significantly retained the memory of learned task. These findings suggest that sulforaphane might be a promising therapeutic agent for cognitive enhancement in

  1. Multiple cognitive deficits in patients during the mild cognitive impairment stage of Alzheimer's disease: how are cognitive domains other than episodic memory impaired?

    PubMed

    Matsuda, Osamu; Saito, Masahiko

    2009-10-01

    Little is known about how cognitive domains other than episodic memory are affected during the mild cognitive impairment (MCI) stage of Alzheimer's disease (AD). We attempted to clarify this issue in this study. Fifty-seven Japanese subjects were divided into two groups: one comprising people in the MCI stage of AD (MCI group, n = 28) and the other of normal controls (NC group, n = 29). Cognitive functions were assessed using the Japanese version of the neurobehavioral cognitive status examination (J-COGNISTAT). The MCI group performed significantly worse than the NC group on subtests that assessed orientation, confrontational naming, constructive ability, episodic memory, and abstract thinking. Three-quarters of the MCI group had deficits in memory and other non-mnemonic domains, particularly constructive ability and abstract thinking. However, within-subject comparisons showed that the MCI group performed significantly worse on the memory subtest compared to any other subtest. Besides episodic memory, multiple non-mnemonic cognitive domains, such as constructive ability and abstract thinking, are also impaired during the MCI stage of AD; however, these non-mnemonic deficits are smaller than episodic memory impairment.

  2. Cognitive Impairment and Community Integration Outcomes in Individuals Living With Multiple Sclerosis.

    PubMed

    Hughes, Abbey J; Hartoonian, Narineh; Parmenter, Brett; Haselkorn, Jodie K; Lovera, Jesus F; Bourdette, Dennis; Turner, Aaron P

    2015-11-01

    To determine the association between unique domains of cognitive impairment and community integration in individuals with multiple sclerosis (MS), and to determine the contributions of cognitive impairment to community integration beyond the influence of demographic and clinical variables. Cross-sectional analysis of objective neuropsychological assessment and self-report data. Data were collected during baseline assessment of a randomized, multisite controlled trial of ginkgo biloba for cognitive impairment in MS. Hierarchical regression analyses examined the association between subjective and objective measures of cognitive impairment and 3 domains of community integration, adjusting for relevant covariates. Two Veterans Affairs medical center MS clinics. Adults (N=121; ages 24-65y) with a confirmed MS diagnosis. Not applicable. Primary outcomes were scores on the Home Integration (CIQ-H), Social Integration (CIQ-S), and Productivity (CIQ-P) domains of the Community Integration Questionnaire (CIQ). Cognitive impairment was associated with lower scores on the CIQ-H and CIQ-S, but not the CIQ-P. Greater levels of subjective cognitive impairment were associated with lower scores on the CIQ-H and CIQ-S. Greater levels of objective cognitive impairment, specifically slower processing speed and poorer inhibitory control, were related to lower CIQ-S scores. Subjective and objective measures of cognitive impairment were significantly and independently associated with CIQ-S. Objective cognitive impairment may interfere with participation in social activities. Subjective cognitive impairment is also important to assess, because individuals who perceive themselves to be cognitively impaired may be less likely to participate in both home and social activities. Clinical interventions to enhance community integration in individuals with MS may benefit from addressing objective and subjective cognitive impairment by integrating cognitive rehabilitation approaches with self

  3. Numerical Facility: Convergence of Cognitive and Factor Analytic Models

    DTIC Science & Technology

    1989-09-30

    ability measures spanning Numerical Facility, Perceptual Speed, General Reasoning, and Memory Span factors . The 400 cognitive arithmetic problems...variable showed a direct relation to the General Reasoning and Memory Span factors . The discriminant validity of these results was demonstrated by no...Facility, Perceptual Speed, General Reasoning, and Memory Span factors . Both of the general reasoning measures require knowledge of and/or execution of

  4. An innovative intervention for the treatment of cognitive impairment-Emisymmetric bilateral stimulation improves cognitive functions in Alzheimer's disease and mild cognitive impairment: an open-label study.

    PubMed

    Guerriero, Fabio; Botarelli, Emanuele; Mele, Gianni; Polo, Lorenzo; Zoncu, Daniele; Renati, Paolo; Sgarlata, Carmelo; Rollone, Marco; Ricevuti, Giovanni; Maurizi, Niccolo; Francis, Matthew; Rondanelli, Mariangela; Perna, Simone; Guido, Davide; Mannu, Piero

    2015-01-01

    In the last decade, the development of different methods of brain stimulation by electromagnetic fields (EMF) provides a promising therapeutic tool for subjects with impaired cognitive functions. Emisymmetric bilateral stimulation (EBS) is a novel and innovative EMF brain stimulation, whose working principle is to introduce very weak noise-like stimuli through EMF to trigger self-arrangements in the cortex of treated subjects, thereby improving cognitive faculties. The aim of this pilot study was to investigate in patients with cognitive impairment the effectiveness of EBS treatment with respect to global cognitive function, episodic memory, and executive functions. Fourteen patients with cognitive decline (six with mild cognitive impairment and eight with Alzheimer's disease) underwent three EBS applications per week to both the cerebral cortex and auricular-specific sites for a total of 5 weeks. At baseline, after 2 weeks and 5 weeks, a neuropsychological assessment was performed through mini-mental state examination, free and cued selective reminding tests, and trail making test. As secondary outcomes, changes in behavior, functionality, and quality of life were also evaluated. After 5 weeks of standardized EBS therapy, significant improvements were observed in all neurocognitive assessments. Mini-mental state examination score significantly increased from baseline to end treatment (+3.19, P=0.002). Assessment of episodic memory showed an improvement both in immediate and delayed recalls (immediate recall =+7.57, P=0.003; delayed recall =+4.78, P<0.001). Executive functions significantly improved from baseline to end stimulation (trail making test A -53.35 seconds; P=0.001). Of note, behavioral disorders assessed through neuropsychiatric inventory significantly decreased (-28.78, P<0.001). The analysis concerning the Alzheimer's disease and mild cognitive impairment group confirmed a significant improvement of cognitive functions and behavior after EBS treatment

  5. Life Course Pathways to Racial Disparities in Cognitive Impairment among Older Americans*

    PubMed Central

    Zhang, Zhenmei; Hayward, Mark D.; Yu, Yan-Liang

    2016-01-01

    Blacks are especially hard hit by cognitive impairment at older ages compared to whites. Here, we take advantage of the Health and Retirement Study (1998–2010) to assess how this racial divide in cognitive impairment is associated with the racial stratification of life course exposures and resources over a 12-year period among 8,946 non-Hispanic whites and blacks aged 65 and older in 1998. We find that blacks suffer from a higher risk of moderate/severe cognitive impairment at baseline and during the follow-up. Blacks are also more likely to report childhood adversity and to have grown up in the segregated South, and these early-life adversities put blacks at a significantly higher risk of cognitive impairment. Adulthood socioeconomic status is strongly associated with the risk of cognitive impairment, net of childhood conditions. However, racial disparities in cognitive impairment, though substantially reduced, are not eliminated when controlling for these life course factors. PMID:27247126

  6. AD8 Informant Questionnaire for Cognitive Impairment: Pragmatic Diagnostic Test Accuracy Study.

    PubMed

    Larner, A J

    2015-09-01

    The diagnostic accuracy of the AD8 informant questionnaire for cognitive impairment was assessed in patients referred to a dedicated memory clinic. This pragmatic prospective study of consecutive referrals attending with an informant who completed AD8 (n = 212) lasted 12 months. Diagnosis used standard clinical diagnostic criteria for dementia and mild cognitive impairment as reference standard (prevalence of cognitive impairment = 0.62). The AD8 proved acceptable to informants, was quick, and easy to use. Using the cutoff of ≥2/8, AD8 was highly sensitive (0.97) for diagnosis of cognitive impairment but specificity was poor (0.17). Combining AD8 with either the Mini-Mental State Examination or the Six-Item Cognitive Impairment Test showed little additional diagnostic benefit. In conclusion, AD8 is very sensitive for cognitive impairment in a memory clinic but specificity may be inadequate.

  7. Cognitive impairment in childhood onset epilepsy: up-to-date information about its causes

    PubMed Central

    Kim, Eun-Hee

    2016-01-01

    Cognitive impairment associated with childhood-onset epilepsy is an important consequence in the developing brain owing to its negative effects on neurodevelopmental and social outcomes. While the cause of cognitive impairment in epilepsy appears to be multifactorial, epilepsy-related factors such as type of epilepsy and underlying etiology, age at onset, frequency of seizures, duration of epilepsy, and its treatment are considered important. In recent studies, antecedent cognitive impairment before the first recognized seizure and microstructural and functional alteration of the brain at onset of epilepsy suggest the presence of a common neurobiological mechanism between epilepsy and cognitive comorbidity. However, the overall impact of cognitive comorbidity in children with epilepsy and the independent contribution of each of these factors to cognitive impairment have not been clearly delineated. This review article focuses on the significant contributors to cognitive impairment in children with epilepsy. PMID:27186225

  8. Elevated Rates of Mild Cognitive Impairment in HIV Disease

    PubMed Central

    Sheppard, David P.; Iudicello, Jennifer E.; Bondi, Mark W.; Doyle, Katie L.; Morgan, Erin E.; Massman, Paul J.; Gilbert, Paul E.; Woods, Steven Paul

    2015-01-01

    With the rising number of individuals in their 50s and 60s who are infected with HIV, concerns have emerged about possible increases in the rates of non-HIV-associated dementias. The current study examined the prevalence of mild cognitive impairment (MCI) in older HIV-infected adults, since MCI is an intermediate state between typical cognitive aging and dementia that emerges in this age range. Participants included 75 adults with HIV disease aged 50 years and older who were on cART and had undetectable plasma viral loads and 80 demographically similar HIV seronegative comparison subjects. Participants completed a research neuropsychological evaluation that was used to classify MCI according to the comprehensive diagnostic scheme described by Bondi et al. (2014). HIV-infected persons were over seven times more likely to have an MCI designation (16%) than their seronegative counterparts (2.5%). Within the HIV+ cohort, MCI had minimal overlap with diagnoses of Asymptomatic Neurocognitive Impairment and was significantly associated with older age, lower Karnofsky Scale of Performance Scores, and mild difficulties performing instrumental activities of daily living (iADLs). HIV infection in older adults is associated with a notably elevated concurrent risk of MCI, which may increase the likelihood of developing non-HIV-associated dementias as this population ages further. PMID:26139019

  9. Type 2 diabetes and ethnic disparities in cognitive impairment

    PubMed Central

    Noble, James M.; Manly, Jennifer J.; Schupf, Nicole; Tang, Ming-Xing; Luchsinger, José A.

    2012-01-01

    Objectives We explored whether ethnic differences in type 2 diabetes (T2D) explain ethnic disparities in cognitive impairment. Design longitudinal study Setting A cohort study of multiethnic community dwelling elderly persons in Northern Manhattan, New York. Participants 941 participants aged ≥ 65 years without prevalent cognitive impairment or dementia (CID) were followed for a median of 7.1 years. Main Outcomes Measures CID was defined by a clinical dementia rating ≥ 0.5. CID risk attributable to T2D was estimated for each ethnic group using the hazard ratio (HR) relating T2D and CID and the ethnic prevalence of T2D. Results 448 participants developed CID (69 (31.4%) Non-Hispanic Whites (Whites), 152 (48.6%) Non-Hispanic-Blacks (Blacks), 227 (55.6%) Hispanics, p<0.001). T2D prevalence was 8.2% in Whites, 20.1% in Blacks, and 19.6 % in Hispanics, p<0.001. Controlling for age, gender, education, and APOEε4, the HR relating T2D and CID was 1.63 (95% CI 1.26, 2.09). CID attributable to T2D was higher in Blacks and Hispanics compared to Whites (11.4% vs. 4.9%; p=0.06). We estimated that reducing the ethnic disparities in diabetes prevalence could reduce the CID ethnic disparities by 17%. Conclusions Reducing ethnic differences in T2D prevalence could partially reduce ethnic differences in incident CID. PMID:22774307

  10. Cost template for meaningful activity intervention for mild cognitive impairment.

    PubMed

    Lu, Yvonne Yueh-Feng; Bakas, Tamilyn; Haase, Joan E

    2013-01-01

    The objective of the study was to describe and compare cost estimates for a pilot study of the Daily Enhancement of Meaningful Activity intervention for persons with mild cognitive impairment-caregiver dyads. The increasing complexity of the healthcare system and rising healthcare costs have forced nurse scientists to find ways to effectively improve healthcare quality and control cost, but no studies have examined costs for new programs that target persons with mild cognitive impairment-caregiver dyads. Pilot study data were used to develop a cost template and calculate the cost of implementing the Daily Enhancement of Meaningful Activity. Mean cost per dyad was estimated to be $1327.97 in the clinical setting, compared with $1069.06 if a telephone delivery mode had been used for 4 of the 6 face-to-face sessions. This difference was largely due to transportation-related expenses and staff cost. : Daily Enhancement of Meaningful Activity should be evaluated further with larger and more diverse samples as a technology-delivered health promotion program that could reduce costs.

  11. Chronic Bickerstaff's encephalitis with cognitive impairment, a reality?

    PubMed

    Renaud, Mathilde; Aupy, Jérôme; Camuset, Guillaume; Collongues, Nicolas; Chanson, Jean-Baptiste; de Seze, Jérôme; Blanc, Frédéric

    2014-05-06

    Bickerstaff's encephalitis (BE) is an acute post-infectious demyelinating disease with albuminocytological dissociation. A chronic form has rarely been described previously. A 44-year-old man was hospitalized for drowsiness, cognitive complaint limb weakness, ataxia and sensory disturbance after diarrhea. Neuropsychological evaluation showed slowing, memory and executive function impairment, while analysis of the CSF showed albuminocytological dissociation. Immunologic tests showed positive anti-ganglioside antibodies (anti-GM1 IgM, anti-GD1a IgG and anti-GD1b IgM). Brain MRI was normal but SPECT showed bilateral temporal and frontal hypoperfusion. Outcome under immunoglobulin treatment (IVIG) was favorable with an initial improvement but was marked by worsening after a few weeks. Consequently, the patient was treated with IVIG every 2 months due to the recurrence of symptoms after 6 weeks. This case raises the question of the existence of a chronic form of BE with cognitive impairment, in the same way as chronic inflammatory demyelinating polyneuropathy is considered to be a chronic form of Guillain-Barré syndrome.

  12. Chronic Bickerstaff’s encephalitis with cognitive impairment, a reality?

    PubMed Central

    2014-01-01

    Background Bickerstaff’s encephalitis (BE) is an acute post-infectious demyelinating disease with albuminocytological dissociation. A chronic form has rarely been described previously. Case presentation A 44-year-old man was hospitalized for drowsiness, cognitive complaint limb weakness, ataxia and sensory disturbance after diarrhea. Neuropsychological evaluation showed slowing, memory and executive function impairment, while analysis of the CSF showed albuminocytological dissociation. Immunologic tests showed positive anti-ganglioside antibodies (anti-GM1 IgM, anti-GD1a IgG and anti-GD1b IgM). Brain MRI was normal but SPECT showed bilateral temporal and frontal hypoperfusion. Outcome under immunoglobulin treatment (IVIG) was favorable with an initial improvement but was marked by worsening after a few weeks. Consequently, the patient was treated with IVIG every 2 months due to the recurrence of symptoms after 6 weeks. Conclusion This case raises the question of the existence of a chronic form of BE with cognitive impairment, in the same way as chronic inflammatory demyelinating polyneuropathy is considered to be a chronic form of Guillain–Barré syndrome. PMID:24885623

  13. Amnestic mild cognitive impairment with low myocardial metaiodobenzylguanidine uptake

    PubMed Central

    Sakakibara, Ryuji; Ogata, Takeshi; Haruta, Masayuki; Kishi, Masahiko; Tsuyusaki, Yohei; Tateno, Akihiko; Tateno, Fuyuki; Mouri, Takayuki

    2012-01-01

    Objectives: We reported cases of amnestic mild cognitive impairment (MCI) without the core clinical features of dementia with Lewy bodies (DLB) (dementia and spontaneous parkinsonism) with low uptake in 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. Methods: During a 3-year period at a university clinic, we had 254 patients with memory complaints; 106 men, 148 women; mean age 72.5 years (48-95 years). In all patients we performed neurologic examination; memory tests including the MMSE, ADAScog, FAB and additional WMS-R; and imaging tests including brain MRI, SPECT and MIBG scintigraphy. Results: The criteria of amnestic MCI were fulfilled in 44 patients; and 13 of them (30%) showed low MIBG uptake. They had the following: uniformly elderly, with an equal sex ratio, have relatively slow progression, preserved general cognitive function (MMSE 24.8/30). In addition to memory impairment, they commonly showed low frontal function by FAB (12.5/18) and some had mild visual hallucination (5). Other than memory disorder, they had autonomic disorder (nocturia in 7, constipation in 2, postural hypotension in one), REM sleep behavioral disorder (in 3) and occipital hypoperfusion by SPECT (in 5). Conclusion: This cohort of multidomain amnestic MCI cases may present with early stage DLB because of the presence of low MIBG uptake. Clinically, they commonly have low FAB, and may have visual hallucination, autonomic and sleep disorders. PMID:23383388

  14. Mild cognitive impairment: Conceptual, assessment, ethical, and social issues

    PubMed Central

    Werner, Perla; Korczyn, Amos D

    2008-01-01

    Mild cognitive impairment (MCI) is defined as a condition characterized by newly acquired cognitive decline to an extent that is beyond that expected for age or educational background, yet not causing significant functional impairment. The concept of MCI has received considerable attention in the literature over the past few years, and aspects related to its definition, prevalence, and evolution have been extensively studied and reviewed. Here we attempt to synthesize the implications of the current status of this entity, focusing on the conceptual, methodological, and, in particular, the social and ethical aspects of MCI which have attracted less attention. We discuss the weaknesses of the concept of MCI, which is heterogeneous in etiology, manifestations, and outcomes, and suggest that the emergence of the syndrome at this stage reflects industrial interests related to possible development of drugs for this disorder. On the other hand, the formal diagnosis of MCI, with its implications that the person may develop dementia, may have a grave impact on the psychological state of the individual, at a stage when prediction of outcome is tenuous and possibilities of useful interventions are meager. We present suggestions for the direction of future research in these areas. PMID:18982912

  15. Precuneus Structure Changes in Amnestic Mild Cognitive Impairment.

    PubMed

    Haussmann, Robert; Werner, Annett; Gruschwitz, Antonia; Osterrath, Antje; Lange, Jan; Donix, Katharina L; Linn, Jennifer; Donix, Markus

    2017-02-01

    Patients with amnestic mild cognitive impairment (aMCI) are at risk for developing Alzheimer's disease. Due to their prominent memory impairment, structural magnetic resonance imaging (MRI) often focuses on the hippocampal region. However, recent positron-emission tomography data suggest that within a network of frontal and temporal changes, patients with aMCI show metabolic alterations in the precuneus, a key region for higher cognitive functions. Using high-resolution MRI and whole-brain cortical thickness analyses in 28 patients with aMCI and 25 healthy individuals, we wanted to investigate whether structural changes in the precuneus would be associated with cortical thickness reductions in frontal and temporal brain regions in patients with aMCI. In contrast to healthy people, patients with aMCI showed an association of cortical thinning in the precuneus with predominantly left-hemispheric thickness reductions in medial temporal and frontal cortices. Our data highlight structural neuronal network characteristics among patients with aMCI.

  16. Visual hallucinations and cognitive impairment in Parkinson's disease.

    PubMed

    Park, Hee Kyung; Kim, Jae Seung; Im, Ki Chun; Kim, Mi Jung; Lee, Jae-Hong; Lee, Myoung C; Kim, Juhan; Chung, Sun Ju

    2013-09-01

    Visual hallucination (VH) is a common psychotic symptom in patients with Parkinson's disease (PD) and may be a significant predictor of cognitive impairment (CI) in such patients. This study aimed to investigate the pattern of glucose metabolism of VH and the relationship between VH and CI in PD. We studied 28 PD patients, including 15 with VH (PD-VH) and 13 without VH (PD-NVH). Of the 15 PD-VH patients, 8 patients had cognitive impairment (PD-VHCI) whereas 7 did not (PD-VHNCI). All patients underwent [18F] fluorodeoxyglucose positron emission tomography ([18F] FDG PET) followed by statistical parametric mapping (SPM) analyses. Compared to the patients with PDNVH, PD-VHNCI patients showed glucose hypometabolism in the inferior and middle temporal cortices, fusiform gyri, and frontal areas, suggesting the involvement of the ventral visual pathway. Compared to the patients with PDNVH, PD-VHCI patients showed glucose hypometabolism in the temporoparietal association cortices with scattered frontal areas. Dysfunction of ventral visual pathway involving the temporal lobe may play a key role in VH development in PD patients. The evolving distribution from the ventral visual pathway to more extensive posterior cortices in PD-VHCI patients suggests that VH may be a prodromal symptom occurring prior to CI in PD patients.

  17. Interference Impacts Working Memory in Mild Cognitive Impairment

    PubMed Central

    Aurtenetxe, Sara; García-Pacios, Javier; del Río, David; López, María E.; Pineda-Pardo, José A.; Marcos, Alberto; Delgado Losada, Maria L.; López-Frutos, José M.; Maestú, Fernando

    2016-01-01

    Mild cognitive impairment (MCI) is considered a transitional stage between healthy aging and dementia, specifically Alzheimer's disease (AD). The most common cognitive impairment of MCI includes episodic memory loss and difficulties in working memory (WM). Interference can deplete WM, and an optimal WM performance requires an effective control of attentional resources between the memoranda and the incoming stimuli. Difficulties in handling interference lead to forgetting. However, the interplay between interference and WM in MCI is not well-understood and needs further investigation. The current study investigated the effect of interference during a WM task in 20 MCIs and 20 healthy elder volunteers. Participants performed a delayed match-to-sample paradigm which consisted in two interference conditions, distraction and interruption, and one control condition without any interference. Results evidenced a disproportionate impact of interference on the WM performance of MCIs, mainly in the presence of interruption. These findings demonstrate that interference, and more precisely interruption, is an important proxy for memory-related deficits in MCI. Thus, the current findings reveal novel evidence regarding the causes of WM forgetting in MCI patients, associated with difficulties in the mechanisms of attentional control. PMID:27790082

  18. The Early Indicators of Functional Decrease in Mild Cognitive Impairment

    PubMed Central

    Kubicki, Alexandre; Fautrelle, Lilian; Bourrelier, Julien; Rouaud, Olivier; Mourey, France

    2016-01-01

    Objectives: Motor deficiency is associated with cognitive frailty in patients with Mild Cognitive Impairments (MCI). In this study we aimed to test the integrity in muscle synergies involved in an arm-pointing movement in functionally unimpaired MCI patients. We hypothesized that early motor indicators exist in this population at a preclinical level. Methods: Electromyographic signals were collected for 11 muscles in 3 groups: Young Adults (YA), Older Adults (OA), and MCI patients. The OA and MCI groups presented the same functional status. Each subject performed 20 arm-pointing movements from a standing position. Results: The main differences were (1) an earlier activation of the left Obliquus internus in MCI compared with OA group, (2) an earlier activation for the MCI compared with both OA and YA. The temporal differences in muscle synergies between MCI and OA groups were linked with executive functions of MCI patients, assessed by the trail making test. Moreover, the results show a delayed activation of the right Biceps Femoris and the right Erector Spinae at l3 in MCI and OA compared with YA. Interpretation: The motor program changes highlighted in our patient MCI group suggest that discrete modifications of the motor command seem to exist even in the absence of functional impairment. Instead of showing an indication of delayed muscle activation in the MCI patients, our results highlight some early activation of several trunk muscles. PMID:27570509

  19. Interference Impacts Working Memory in Mild Cognitive Impairment.

    PubMed

    Aurtenetxe, Sara; García-Pacios, Javier; Del Río, David; López, María E; Pineda-Pardo, José A; Marcos, Alberto; Delgado Losada, Maria L; López-Frutos, José M; Maestú, Fernando

    2016-01-01

    Mild cognitive impairment (MCI) is considered a transitional stage between healthy aging and dementia, specifically Alzheimer's disease (AD). The most common cognitive impairment of MCI includes episodic memory loss and difficulties in working memory (WM). Interference can deplete WM, and an optimal WM performance requires an effective control of attentional resources between the memoranda and the incoming stimuli. Difficulties in handling interference lead to forgetting. However, the interplay between interference and WM in MCI is not well-understood and needs further investigation. The current study investigated the effect of interference during a WM task in 20 MCIs and 20 healthy elder volunteers. Participants performed a delayed match-to-sample paradigm which consisted in two interference conditions, distraction and interruption, and one control condition without any interference. Results evidenced a disproportionate impact of interference on the WM performance of MCIs, mainly in the presence of interruption. These findings demonstrate that interference, and more precisely interruption, is an important proxy for memory-related deficits in MCI. Thus, the current findings reveal novel evidence regarding the causes of WM forgetting in MCI patients, associated with difficulties in the mechanisms of attentional control.

  20. Associations of Mild Cognitive Impairment with Hospitalization and Readmission

    PubMed Central

    Callahan, Kathryn E.; Lovato, James F.; Miller, Michael E.; Easterling, Doug; Snitz, Beth; Williamson, Jeff D.

    2016-01-01

    OBJECTIVES To determine whether older adults with mild cognitive impairment (MCI), a condition not previously explored as a risk factor, experience increased hospitalizations and 30-day readmission compared to those with normal cognition. Frequent hospitalizations and unplanned readmissions are recognized as markers of poor quality care for older adults. DESIGN Post-hoc analysis of prospectively gathered data on incident hospitalization and readmission from the Ginkgo Evaluation of Memory Study (GEMS), a randomized double-blind placebo-controlled trial designed to assess the impact of Ginkgo biloba on incidence of dementia. SETTING GEMS was conducted in 5 academic medical centers in the United States. PARTICIPANTS 2742 community-dwelling adults age 75 or older with normal cognition (n=2314) or MCI (n=428) at baseline cognitive testing. MEASUREMENTS Index hospitalization and 30-day hospital readmission, adjusted for age, sex, race, education, clinic site, trial assignment status, comorbidities, number of prescription medications, and living with an identified proxy. RESULTS MCI was associated with a 17% increase in the hazard of index hospitalization as compared with normal cognition (adjusted Hazard Ratio (HR)=1.17 (1.02 – 1.34)). In participants who lived with their proxy, MCI was associated with a 39% increased hazard of index hospitalization (adjusted HR=1.392 (1.169 – 1.657)). Baseline MCI was not associated with increased odds of 30-day hospital readmission (adjusted Odds Ratio=0.90 (0.60 – 1.36)). CONCLUSION MCI may represent a target condition for healthcare providers to coordinate support services in an effort to reduce hospitalization and subsequent disability. PMID:26313420

  1. Phase Measurement of Cognitive Impairment Specific to Radiotherapy

    SciTech Connect

    Armstrong, Carol L.; Shera, David M.; Lustig, Robert A.; Phillips, Peter C.

    2012-07-01

    Purpose: Memory impairment is an early-delayed effect of radiotherapy (RT). The prospective longitudinal measurement of the cognitive phase effects from RT was conducted on treated and untreated brain tumor patients. The study design investigated semantic vs. perceptual and visual vs. verbal memory to determine the most disease-specific measure of RT-related changes and understanding of the neurotoxicity from RT to the brain. Methods and Materials: Tests of memory that had previously shown RT-related phasic changes were compared with experimental tests of memory to test hypotheses about cognition targeted to the neural toxicity of RT. The results from 41 irradiated and 29 nonirradiated patients with low-grade, supratentorial tumors were analyzed. The methods controlled for comorbid white matter risk, recurrence, interval after treatment, and age (18-69 years). The effects were examined before RT and at three points after RT to 1 year using a mixed effects model that included interval, group, surgical status, medication use, practice, and individual random effects. Four new tests of memory and other candidate cognitive tests were investigated, and a post hoc analysis of a comprehensive battery of tests was performed to identify the cognitive processes most specific to RT. Results: The RT effects on memory were identified in the treated group only; among the new tests of memory and the complete neurocognitive battery, the RT effects were significant only for delayed recall (p < 0.009) and interval to recognize (p < 0.002). Tumor location was not related to the treatment effect. Memory decline was specific to retrieval of semantic memories; a double dissociation of semantic from perceptual visual memory was demonstrated in the RT group. Conclusions: These results implicate memory dependent on the semantic cortex and the hippocampal memory system. A cognitive measurement that is brief but specific to neural mechanisms is effective and feasible for studies of RT damage.

  2. Prevalence of mild behavioral impairment in mild cognitive impairment and subjective cognitive decline, and its association with caregiver burden.

    PubMed

    Sheikh, Faisal; Ismail, Zahinoor; Mortby, Moyra E; Barber, Philip; Cieslak, Alicja; Fischer, Karyn; Granger, Robert; Hogan, David B; Mackie, Aaron; Maxwell, Colleen J; Menon, Bijoy; Mueller, Patricia; Patry, David; Pearson, Dawn; Quickfall, Jeremy; Sajobi, Tolulope; Tse, Eric; Wang, Meng; Smith, Eric E

    2017-09-07

    Mild behavioral impairment (MBI) describes later life acquired, sustained neuropsychiatric symptoms (NPS) in cognitively normal individuals or those with mild cognitive impairment (MCI), as an at-risk state for incident cognitive decline and dementia. We developed an operational definition of MBI and tested whether the presence of MBI was related to caregiver burden in patients with subjective cognitive decline (SCD) or MCI assessed at a memory clinic. MBI was assessed in 282 consecutive memory clinic patients with SCD (n = 119) or MCI (n = 163) in accordance with the International Society to Advance Alzheimer's Research and Treatment - Alzheimer's Association (ISTAART-AA) research diagnostic criteria. We operationalized a definition of MBI using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Caregiver burden was assessed using the Zarit caregiver burden scale. Generalized linear regression was used to model the effect of MBI domains on caregiver burden. While MBI was more prevalent in MCI (85.3%) than in SCD (76.5%), this difference was not statistically significant (p = 0.06). Prevalence estimates across MBI domains were affective dysregulation (77.8%); impulse control (64.4%); decreased motivation (51.7%); social inappropriateness (27.8%); and abnormal perception or thought content (8.7%). Affective dysregulation (p = 0.03) and decreased motivation (p=0.01) were more prevalent in MCI than SCD patients. Caregiver burden was 3.35 times higher when MBI was present after controlling for age, education, sex, and MCI (p < 0.0001). MBI was common in memory clinic patients without dementia and was associated with greater caregiver burden. These data show that MBI is a common and clinically relevant syndrome.

  3. Efficacy of physical exercise in preventing falls in older adults with cognitive impairment: a systematic review and meta-analysis.

    PubMed

    Chan, Wai Chi; Yeung, Jerry Wing Fai; Wong, Corine Sau Man; Lam, Linda Chiu Wa; Chung, Ka Fai; Luk, James Ka Hay; Lee, Jenny Shun Wah; Law, Andrew Chi Kin

    2015-02-01

    Numerous studies have reported the prevention of falls through exercise among cognitively healthy older people. This study aimed to determine whether the current evidence supports that physical exercise is also efficacious in preventing falls in older adults with cognitive impairment. Two independent reviewers searched MEDLINE; EMBASE; PsycINFO; the Cumulative Index to Nursing & Allied Health Literature; the Cochrane Central Register of Controlled Trials; the Cochrane Bone, Joint, and Muscle Trauma Group Specialized Register; ClinicalTrials.gov; and the UK Clinical Research Network Study Portfolio up to July 2013 without language restriction. We included randomized controlled trials that examined the efficacy of physical exercise in older adults with cognitive impairment. The methodological qualities of the included trials were appraised according to the criteria developed for the Cochrane review of fall prevention trials. The primary outcome measure was the rate ratio of falls. A meta-analysis was performed to estimate the pooled rate ratio and summarize the results of the trials on fall prevention through physical exercise. Seven randomized controlled trials involving 781 participants were included, 4 of which examined solely older people with cognitive impairment. Subgroup data on persons with cognitive impairment were obtained from the other 3 trials that targeted older populations in general. The meta-analysis showed that physical exercise had a significant effect in preventing falls in older adults with cognitive impairment, with a pooled estimate of rate ratio of 0.68 (95% confidence interval 0.51-0.91). The present analysis suggests that physical exercise has a positive effect on preventing falls in older adults with cognitive impairment. Further studies will be required to determine the modality and frequency of exercise that are optimal for the prevention of falls in this population. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care

  4. Hypoxia induced cognitive impairment modulating activity of Cyperus rotundus.

    PubMed

    Kandikattu, Hemanth Kumar; Deep, Satya Narayan; Razack, Sakina; Amruta, Narayanappa; Prasad, Dipti; Khanum, Farhath

    2017-03-27

    Hypobaric hypoxia leads to decrease in cellular oxygen content which subsequently damages the hippocampus with an increase in brain oxidative stress and impairs the memory of the individual. In the present study, we have evaluated the cognitive impairment modulating activity of total oligomeric flavonoids fraction of Cyperus rotundus (TOF) in Sprague Dawley rats. The rats were trained for memory activity for a period of 7days followed by 7days exposure to 25,000ft. altitude and the spatial reference memory was evaluated. Behavioral analysis of the rats by Morris water maze experiment showed that TOF supplementation enhanced the spatial reference memory activity of the rats exposed to hypobaric hypoxia. The decrease in antioxidant status of the animals exposed to hypoxia was restored with TOF supplementation. The increase in ROS, lipid peroxidation products and protein carbonyls of the hippocampus was significantly decreased in animals with TOF administration. The histological assessment of the pyramidal cells of the hippocampus of hypoxia-exposed animals showed nuclear damage and TOF supplementation prevented nuclear damage. TOF administration suppressed hypoxia-induced increase in serotonin, dopamine, and norepinephrine. GABA and Ach levels were decreased by hypoxia which was prevented by TOF supplementation. The increase in GFAP, HIF-1α and VEGF expression in CA3 region of the hippocampus in hypoxia-exposed rats was decreased in TOF administered rats. Taken together, TOF extract ameliorates hypobaric hypoxia induced memory impairment and neurodegeneration in hippocampus through its anti-stress effects.

  5. Impaired cognitive control over emotional material in euthymic bipolar disorder.

    PubMed

    Wolkenstein, Larissa; Kanske, Philipp; Bailer, Josef; Wessa, Michèle; Hautzinger, Martin; Joormann, Jutta

    2017-05-01

    Previous research suggests that bipolar disorder (BD) is characterized by deficits in cognitive control (CC). Impaired CC has been found in high-risk samples and is associated with the maintenance of BD symptoms. It remains unclear, however, whether BD is characterized by a general deficit in CC or by a deficit that is specifically related to the processing of emotional material. The sample consisted of 42 remitted bipolar patients and 39 healthy controls (HC). We examined whether BD individuals display impaired CC when confronted with negative as well as positive material using an arithmetic inhibition task that required inhibition of pictorial stimulus material. Whereas both groups showed difficulties in exerting CC over negative material, only BD individuals exhibited deficient CC over positive material. Even though we intended the negative and positive pictures in the arithmetic inhibition task to be similarly arousing, participants in the current study rated the negative compared to the positive pictures as more arousing. BD is associated with impaired CC when processing emotional - especially positive - stimuli even when patients are in remission. Possible implications of this deficit especially for emotion regulation are discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Protective effect of rutin on cognitive impairment caused by phenytoin

    PubMed Central

    Dubey, Shagun; Ganeshpurkar, Aditya; Bansal, Divya; Dubey, Nazneen

    2015-01-01

    Objective: To study the effect of the co-administration of phenytoin (PHT) and rutin in comparison with PHT and piracetam (PIM) on seizure control, cognitive, and motor functions in mice. Materials and Methods: Increasing current electroshock seizure (ICES) test was used to evaluate the effect of the co-administration of PHT and PIM on convulsions. Cognitive functions in mice were assessed by a spontaneous alternation in behavior on a plus maze while motor functions were screened using rolling roller apparatus and by counting the number of arms entries on a plus maze. Brain acetyl-cholinesterase (AChE) activity was also estimated. Statistical Analysis: The expression of data was done as mean ± standard error of the mean. The normally distributed data were subjected to one-way ANOVA followed by Dunnett's test. P < 0.05 was considered significant. Results: The study showed that rutin when co-administered with PHT, significantly reversed PHT-induced reduction in spontaneous alternation without altering the efficacy of PHT against ICES, in both acute and chronic studies. Further, it also reversed PHT-induced increase in AChE activity. Conclusion: Rutin alleviated the PHT-induced cognitive impairment without compromising its antiepileptic efficacy. PMID:26729954

  7. Risk factors for mild cognitive impairment among Mexican Americans

    PubMed Central

    O’Bryant, Sid E.; Johnson, Leigh; Reisch, Joan; Edwards, Melissa; Hall, James; Barber, Robert; Devous, Michael; Royall, Donald; Singh, Meharvan

    2013-01-01

    Background While a great deal of literature has focused on risk factors for Mild Cognitive Impairment (MCI), little published work examines risk for MCI among Mexican Americans. Methods Data from 1628 participants (non-Hispanic n= 1002; Mexican American n=626) were analyzed from two ongoing studies of cognitive aging and Alzheimer’s disease, Project FRONTIER and TARCC. Results When looking at the full cohorts (non-Hispanic and Mexican American), age, education, APOE ε4 status and gender were consistently related to MCI diagnosis across the two cohorts. However, when split by ethnicity advancing age was the only significant risk factor for MCI among Mexican Americans across both cohorts. Conclusions The current data suggests that many of the previously established risk factors for MCI among non-Hispanic cohorts may not be predictive of MCI among Mexican Americans and point to the need for additional work aimed at understanding factors related to cognitive aging among this underserved segment of the population. PMID:23643456

  8. Influence of cognitive impairment on the management of ischaemic stroke.

    PubMed

    Murao, K; Bombois, S; Cordonnier, C; Hénon, H; Bordet, R; Pasquier, F; Leys, D

    2014-03-01

    Because of ageing of the population, it is more and more frequent to treat ischaemic stroke patients with pre-stroke cognitive impairment (PSCI). Currently, there is no specific recommendation on ischaemic stroke management in these patients, both at the acute stage and in secondary prevention. However, these patients are less likely to receive treatments proven effective in randomised controlled trials, even in the absence of contra-indication. To review the literature to assess efficacy and safety of validated therapies for acute ischaemic stroke and secondary prevention in PSCI patients. Most randomised trials did not take into account the pre-stroke cognitive status. The few observational studies conducted at the acute stage or in secondary prevention, did not provide any information that the benefit could be either lost or replaced by harm in the presence of PSCI. There is no reason not to treat ischaemic stroke patients with PSCI according to the currently available recommendations for acute management and secondary prevention. Further observational studies are needed and pre-stroke cognition should be taken into account in future stroke trials. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  9. Protective effect of rutin on cognitive impairment caused by phenytoin.

    PubMed

    Dubey, Shagun; Ganeshpurkar, Aditya; Bansal, Divya; Dubey, Nazneen

    2015-01-01

    To study the effect of the co-administration of phenytoin (PHT) and rutin in comparison with PHT and piracetam (PIM) on seizure control, cognitive, and motor functions in mice. Increasing current electroshock seizure (ICES) test was used to evaluate the effect of the co-administration of PHT and PIM on convulsions. Cognitive functions in mice were assessed by a spontaneous alternation in behavior on a plus maze while motor functions were screened using rolling roller apparatus and by counting the number of arms entries on a plus maze. Brain acetyl-cholinesterase (AChE) activity was also estimated. The expression of data was done as mean ± standard error of the mean. The normally distributed data were subjected to one-way ANOVA followed by Dunnett's test. P < 0.05 was considered significant. The study showed that rutin when co-administered with PHT, significantly reversed PHT-induced reduction in spontaneous alternation without altering the efficacy of PHT against ICES, in both acute and chronic studies. Further, it also reversed PHT-induced increase in AChE activity. Rutin alleviated the PHT-induced cognitive impairment without compromising its antiepileptic efficacy.

  10. Caregivers in China: knowledge of mild cognitive impairment.

    PubMed

    Dai, Baozhen; Mao, Zongfu; Mei, John; Levkoff, Sue; Wang, Huali; Pacheco, Misty; Wu, Bei

    2013-01-01

    This study aimed to examine the experience and knowledge of mild cognitive impairment (MCI) among Chinese family caregivers of individuals with MCI. The sample was recruited from memory clinics in Zhongnan Hospital in Wuhan, China. In-depth semi-structured interviews were used. Thirteen family members of individuals diagnosed with MCI participated in the study. Data analysis revealed three themes: 1) initial recognition of cognitive decline; 2) experience of the diagnosis of MCI; 3) perception of cognitive decline as a normal part of aging. While family members recognized the serious consequences of memory loss (e.g. getting lost), they would typically not take their family members to see a doctor until something specific triggered their access to the medical care system. The Chinese traditional perception of dementia as part of normal aging may serve to lessen the stigma of individuals with MCI, while the term "laonian chidai" which literally translates to "stupid, demented elderly" may exacerbate the stigma associated with individuals with MCI. It is suggested that family members' worries may be relieved by improving their access to accurate knowledge of the disease, community-based and institutional care services, and culturally appropriately words are needed for MCI.

  11. Caregivers in China: Knowledge of Mild Cognitive Impairment

    PubMed Central

    Dai, Baozhen; Mao, Zongfu; Mei, John; Levkoff, Sue; Wang, Huali; Pacheco, Misty; Wu, Bei

    2013-01-01

    This study aimed to examine the experience and knowledge of mild cognitive impairment (MCI) among Chinese family caregivers of individuals with MCI. The sample was recruited from memory clinics in Zhongnan Hospital in Wuhan, China. In-depth semi-structured interviews were used. Thirteen family members of individuals diagnosed with MCI participated in the study. Data analysis revealed three themes: 1) initial recognition of cognitive decline; 2) experience of the diagnosis of MCI; 3) perception of cognitive decline as a normal part of aging. While family members recognized the serious consequences of memory loss (e.g. getting lost), they would typically not take their family members to see a doctor until something specific triggered their access to the medical care system. The Chinese traditional perception of dementia as part of normal aging may serve to lessen the stigma of individuals with MCI, while the term “laonian chidai” which literally translates to “stupid, demented elderly” may exacerbate the stigma associated with individuals with MCI. It is suggested that family members’ worries may be relieved by improving their access to accurate knowledge of the disease, community-based and institutional care services, and culturally appropriately words are needed for MCI. PMID:23326541

  12. Association between family functioning and cognitive impairment among Chinese nonagenarians/centenarians.

    PubMed

    Wang, Binyou; He, Ping; Dong, Birong

    2015-09-01

    We explored the association between family functioning and cognitive impairment in the very elderly aged 90-108 years. The present study comprised data from subjects included in the 2005 Project of Longevity and Aging in Dujiangyan, China. Sociodemographic and family functioning data were collected, and cognitive function was assessed in all subjects using the Mini-Mental State Examination. Data from 699 Chinese nonagenarians and centenarians were included. The prevalence of cognitive impairment was 62.8%. The prevalence of family dysfunction was 52.2%, including 8.6% severe and 43.6% moderate dysfunction. There were significant differences among individuals with different family functioning level with regard to cognitive function scores (P = 0.005) or cognitive impairment prevalence (P = 0.012). Subjects with cognitive impairment had lower family functioning scores than those without cognitive impairment (P = 0.004). Pearson's correlation analysis showed that family functioning scores were correlated with Mini-Mental State Examination scores (r = 0.13, P = 0.001). Multiple logistic regressions showed that severe family dysfunction was a risk factor for cognitive impairment. The effect remained after adjusting for sociodemographic status, life habits and metabolic indicators. Family functioning was related to cognitive impairment among Chinese nonagenarians and centenarians. We found that the higher the family functioning scores, the higher the Mini-Mental State Examination scores. Severe family dysfunction was associated with increased risk of cognitive impairment. © 2014 Japan Geriatrics Society.

  13. Two Systems of Non-Symbolic Numerical Cognition

    PubMed Central

    Hyde, Daniel C.

    2011-01-01

    Studies of human adults, infants, and non-human animals demonstrate that non-symbolic numerical cognition is supported by at least two distinct cognitive systems: a “parallel individuation system” that encodes the numerical identity of individual items and an “approximate number system” that encodes the approximate numerical magnitude, or numerosity, of a set. The exact nature and role of these systems, however, have been debated for over a 100-years. Some argue that the non-symbolic representation of small numbers (<4) is carried out solely by the parallel individuation system and the non-symbolic representation of large numbers (>4) is carried out solely by the approximate number system. Others argue that all numbers are represented by the approximate number system. This debate has been fueled largely by some studies showing dissociations between small and large number processing and other studies showing similar processing of small and large numbers. Recent work has addressed this debate by showing that the two systems are present and distinct from early infancy, persist despite the acquisition of a symbolic number system, activate distinct cortical networks, and engage differentially based attentional constraints. Based on the recent discoveries, I provide a hypothesis that may explain the puzzling findings and makes testable predictions as to when each system will be engaged. In particular, when items are presented under conditions that allow selection of individuals, they will be represented as distinct mental items through parallel individuation and not as a numerical magnitude. In contrast, when items are presented outside attentional limits (e.g., too many, too close together, under high attentional load), they will be represented as a single mental numerical magnitude and not as distinct mental items. These predictions provide a basis on which researchers can further investigate the role of each system in the development of uniquely human

  14. Two systems of non-symbolic numerical cognition.

    PubMed

    Hyde, Daniel C

    2011-01-01

    Studies of human adults, infants, and non-human animals demonstrate that non-symbolic numerical cognition is supported by at least two distinct cognitive systems: a "parallel individuation system" that encodes the numerical identity of individual items and an "approximate number system" that encodes the approximate numerical magnitude, or numerosity, of a set. The exact nature and role of these systems, however, have been debated for over a 100-years. Some argue that the non-symbolic representation of small numbers (<4) is carried out solely by the parallel individuation system and the non-symbolic representation of large numbers (>4) is carried out solely by the approximate number system. Others argue that all numbers are represented by the approximate number system. This debate has been fueled largely by some studies showing dissociations between small and large number processing and other studies showing similar processing of small and large numbers. Recent work has addressed this debate by showing that the two systems are present and distinct from early infancy, persist despite the acquisition of a symbolic number system, activate distinct cortical networks, and engage differentially based attentional constraints. Based on the recent discoveries, I provide a hypothesis that may explain the puzzling findings and makes testable predictions as to when each system will be engaged. In particular, when items are presented under conditions that allow selection of individuals, they will be represented as distinct mental items through parallel individuation and not as a numerical magnitude. In contrast, when items are presented outside attentional limits (e.g., too many, too close together, under high attentional load), they will be represented as a single mental numerical magnitude and not as distinct mental items. These predictions provide a basis on which researchers can further investigate the role of each system in the development of uniquely human numerical

  15. Cognitive screening for dementia and mild cognitive impairment in assisted living: comparison of 3 tests.

    PubMed

    Kaufer, Daniel I; Williams, Christianna S; Braaten, Alyssa J; Gill, Karminder; Zimmerman, Sheryl; Sloane, Philip D

    2008-10-01

    Compare diagnostic characteristics of brief cognitive screening tests in residential care/assisted living (RC/AL) residents. Cross-sectional study involving a comprehensive clinical examination to ascertain a consensus diagnosis of probable dementia, no significant cognitive impairment, or mild cognitive impairment (MCI), including both amnestic and non-amnestic subtypes. Fourteen RC/AL facilities in North Carolina. Participants were 146 RC/AL residents, aged 65 years or older, who did not have diagnosed cognitive impairment. Diagnostic characteristics of the Mini-Cog, the Mini-Mental State Exam (MMSE), and a new 50-point test based on expanding selected MMSE items (MMX). Overall, 55/146 (38%) participants were diagnosed with probable dementia, and 76 (52%) met criteria for MCI (most non-amnestic). Both the Mini-Cog and the MMSE showed high sensitivity and negative predictive value for dementia, but had relatively low sensitivity and negative predictive value for MCI. The Mini-Cog had low specificity and was less accurate as a dementia screen than either the MMSE or MMX. Reliability and validity data for the MMX were satisfactory, and it performed better as a screening test for MCI than either the MMSE or Mini-Cog. Although the MMSE and Mini-Cog are both sensitive to dementia, modest specificity and positive predictive value may limit their utility as screening tools. Preliminary MMX data suggest it improves screening for MCI compared to the Mini-Cog or MMSE, while providing a similar level of screening for dementia. Further work is needed to identify suitable instruments for cognitive screening across the range of MCI and dementia.

  16. Quality of life and mild cognitive impairment in early Parkinson's disease: does subtype matter?

    PubMed

    Lawson, Rachael A; Yarnall, Alison J; Duncan, Gordon W; Khoo, Tien K; Breen, David P; Barker, Roger A; Collerton, Daniel; Taylor, John-Paul; Burn, David J

    2014-01-01

    We evaluated the association between mild cognitive impairment (MCI) subtypes and quality of life (QoL) in 219 newly diagnosed Parkinson's disease (PD) patients without dementia. Participants completed neuropsychological tests of attention, executive function, visuospatial function, memory, and language, and reported QoL using the Parkinson's Disease Questionnaire. Impairments were most common in executive function, memory and attention. MCI subtypes were classified according to Movement Disorder Society Task Force criteria. More severe cognitive impairment was associated with poorer quality of life (p = 0.01), but subtype of impairment was not (p > 0.10), suggesting that the nature of cognitive impairment is less significant than its severity.

  17. Neuroanatomy of impaired self-awareness in Alzheimer's disease and mild cognitive impairment.

    PubMed

    Zamboni, Giovanna; Drazich, Erin; McCulloch, Ellen; Filippini, Nicola; Mackay, Clare E; Jenkinson, Mark; Tracey, Irene; Wilcock, Gordon K

    2013-03-01

    Patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) may be unaware of their cognitive impairment. The neuroanatomical mechanisms underlying this symptom, termed anosognosia or impaired self-awareness, are still poorly understood. In the present study we aimed to explore the functional correlates of self-awareness in patients with MCI and AD. Fifty-one participants (17 healthy elderly, 17 patients with MCI, and 17 patients with AD), each accompanied by a study partner, took part in a functional magnetic resonance imaging (fMRI) study, in which they were presented with questions regarding themselves (Self condition) or their study partner (Other condition). The study partner was asked to complete a paper questionnaire answering the same questions so the responses of participant and study partner could be compared and "discrepancy" scores calculated for each of the 2 conditions (Self and Other). Behavioural results showed that AD patients had significantly higher "Self discrepancy scores" than controls and MCI patients, whereas there were no significant differences between groups for "Other discrepancy scores". Imaging results showed a significant group-by-condition interaction in brain activation in medial prefrontal and anterior temporal regions, with AD patients showing significantly decreased activation in these regions only for the Self condition. There were no significant differences between Self and Other conditions in either control or MCI groups, suggesting that, in these groups, Self- and Other-appraisal share similar neuroanatomical substrates. Decreased functional activation of medial prefrontal and anterior temporal cortices is associated with impaired self-awareness in AD patients. This dysfunction, which is specific for Self- but not for Other-appraisal, may be a contributing factor to anosognosia in AD. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Relationship between regional atrophy rates and cognitive decline in mild cognitive impairment

    PubMed Central

    McDonald, Carrie R.; Gharapetian, Lusineh; McEvoy, Linda K.; Fennema-Notestine, Christine; Hagler, Donald J.; Holland, Dominic; Dale, Anders M.

    2010-01-01

    We investigated the relationship between regional atrophy rates and 2-year cognitive decline in a large cohort of patients with mild cognitive impairment (MCI; N=103) and healthy controls (N=90). Longitudinal MRIs were analyzed using high-throughput image analysis procedures. Atrophy rates were derived by calculating percent cortical volume loss between baseline and 24-month scans. Step-wise regressions were performed to investigate the contribution of atrophy rates to language, memory, and executive functioning decline, controlling for age, gender, baseline performances, and disease progression. In MCI, left temporal lobe atrophy rates were associated with naming decline, whereas bilateral temporal, left frontal, and left anterior cingulate atrophy rates were associated with semantic fluency decline. Left entorhinal atrophy rate was associated with memory decline and bilateral frontal atrophy rates were associated with executive function decline. These data provide evidence that regional atrophy rates in MCI contribute to domain-specific cognitive decline, which appears to be partially independent of disease progression. MRI measures of regional atrophy can provide valuable information for understanding the neural basis of cognitive impairment in MCI. PMID:20471718

  19. Callosal degeneration topographically correlated with cognitive function in amnestic mild cognitive impairment and Alzheimer's disease dementia.

    PubMed

    Wang, Pei-Ning; Chou, Kun-Hsien; Chang, Ni-Jung; Lin, Ker-Neng; Chen, Wei-Ta; Lan, Gong-Yau; Lin, Ching-Po; Lirng, Jiing-Feng

    2014-04-01

    Degeneration of the corpus callosum (CC) is evident in the pathogenesis of Alzheimer's disease (AD). However, the correlation of microstructural damage in the CC on the cognitive performance of patients with amnestic mild cognitive impairment (aMCI) and AD dementia is undetermined. We enrolled 26 normal controls, 24 patients with AD dementia, and 40 single-domain aMCI patients with at least grade 1 hippocampal atrophy and isolated memory impairment. Diffusion tensor imaging (DTI) with fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (DA), and radial diffusivity (DR) were measured. The entire CC was parcellated based on fiber trajectories to specific cortical Brodmann areas using a probabilistic tractography method. The relationship between the DTI measures in the subregions of the CC and cognitive performance was examined. Although the callosal degeneration in the patients with aMCI was less extended than in the patients with AD dementia, degeneration was already exhibited in several subregions of the CC at the aMCI stage. Scores of various neuropsychological tests were correlated to the severity of microstructural changes in the subregional CC connecting to functionally corresponding cortical regions. Our results confirm that CC degeneration is noticeable as early as the aMCI stage of AD and the disconnection of the CC subregional fibers to the corresponding Brodmann areas has an apparent impact on the related cognitive performance. Copyright © 2013 Wiley Periodicals, Inc.

  20. Improving vocational outcomes in first-episode psychosis by addressing cognitive impairments using Cognitive Adaptation Training.

    PubMed

    Allott, Kelly A; Killackey, Eoin; Sun, Pamela; Brewer, Warrick J; Velligan, Dawn I

    2017-01-01

    Cognitive Adaptation Training (CAT) uses compensatory strategies and environmental supports to support cognitive impairments and improve functioning. CAT may be useful for addressing vocational recovery in first-episode psychosis (FEP) because cognitive impairments are common and vocational recovery is a key goal of young people with FEP. To describe clinical observations and practice experience when delivering CAT with FEP clients and explore potential benefits via objective outcome measures for improving vocational outcomes. In this pilot study, five FEP participants received 9 months of CAT. Participant goals and functional needs and clinical observations were recorded. Formal measures of functioning, quality of life and motivation were independently administered pre- and post-intervention. Vocational recovery (education, employment) was found to be a primary functional goal of FEP participants. Accordingly, CAT had a strong focus on vocational functioning, including functional domains required for successful work or educational outcomes, such as organization and planning, transportation and activities of daily living. Factors of clinical importance when delivering CAT with the FEP participants included cognitive heterogeneity, family involvement, flexibility in compensatory and environmental supports used, and experience of stigma. Improvements from baseline to post-intervention were observed on most measures, with the largest improvements seen in global functioning (including vocation), planning and organization, and quality of life. CAT is an intervention that appears well suited to addressing vocational functioning in FEP, but larger controlled trials are needed.

  1. Cognitive function in normal aging and in older adults with mild cognitive impairment.

    PubMed

    Ballesteros, Soledad; Mayas, Julia; Reales, José Manuel

    2013-02-01

    In this study, we investigated the effects of normal and pathological (mild cognitive impairment, MCI) aging on several cognitive functions (processing speed, executive control and implicit memory). Twenty young adults, 20 healthy older adults and 20 elders with MCI performed a series of cognitive tasks under controlled conditions. These tasks were simple and choice reaction time, the Wisconsin Card Sorting Test (WCST), and an implicit memory task for attended and unattended objects at encoding. The MCI group showed pronounced declines in processing speed and executive control tasks. Interestingly, young and healthy older participants showed repetition priming for stimuli that were attended at encoding, but the MCI group did not. In this latter group, the lack of repetition priming for attended objects in the implicit memory task resembled that of Alzheimer disease (AD) patients and suggests an early deficit of selective attention that might be a marker of pathological aging.

  2. Cognitive Stimulation Modulates Platelet Total Phospholipases A2 Activity in Subjects with Mild Cognitive Impairment.

    PubMed

    Balietti, Marta; Giuli, Cinzia; Fattoretti, Patrizia; Fabbietti, Paolo; Postacchini, Demetrio; Conti, Fiorenzo

    2016-01-01

    We evaluated the effect of cognitive stimulation (CS) on platelet total phospholipases A2 activity (tPLA2A) in patients with mild cognitive impairment (MCI_P). At baseline, tPLA2A negatively correlated with Mini-Mental State Examination score (MMSE_s): patients with MMSE_s <26 (Subgroup 1) had significantly higher activity than those with MMSE_s ≥26 (Subgroup 2), who had values similar to the healthy elderly. Regarding CS effect, Subgroup 1 had a significant tPLA2A reduction, whereas Subgroup 2 did not significantly changes after training. Our results showed for the first time that tPLA2A correlates with the cognitive conditions of MCI_P, and that CS acts selectively on subjects with a dysregulated tPLA2A.

  3. Cognitive Stimulation Modulates Platelet Total Phospholipases A2 Activity in Subjects with Mild Cognitive Impairment

    PubMed Central

    Balietti, Marta; Giuli, Cinzia; Fattoretti, Patrizia; Fabbietti, Paolo; Postacchini, Demetrio; Conti, Fiorenzo

    2016-01-01

    We evaluated the effect of cognitive stimulation (CS) on platelet total phospholipases A2 activity (tPLA2A) in patients with mild cognitive impairment (MCI_P). At baseline, tPLA2A negatively correlated with Mini-Mental State Examination score (MMSE_s): patients with MMSE_s <26 (Subgroup 1) had significantly higher activity than those with MMSE_s ≥26 (Subgroup 2), who had values similar to the healthy elderly. Regarding CS effect, Subgroup 1 had a significant tPLA2A reduction, whereas Subgroup 2 did not significantly changes after training. Our results showed for the first time that tPLA2A correlates with the cognitive conditions of MCI_P, and that CS acts selectively on subjects with a dysregulated tPLA2A. PMID:26836161

  4. Mild cognitive impairment with suspected nonamyloid pathology (SNAP)

    PubMed Central

    Caroli, Anna; Prestia, Annapaola; Galluzzi, Samantha; Ferrari, Clarissa; van der Flier, Wiesje M.; Ossenkoppele, Rik; Van Berckel, Bart; Barkhof, Frederik; Teunissen, Charlotte; Wall, Anders E.; Carter, Stephen F.; Schöll, Michael; Choo, Il Han; Grimmer, Timo; Redolfi, Alberto; Nordberg, Agneta; Scheltens, Philip; Drzezga, Alexander

    2015-01-01

    Objectives: The aim of this study was to investigate predictors of progressive cognitive deterioration in patients with suspected non–Alzheimer disease pathology (SNAP) and mild cognitive impairment (MCI). Methods: We measured markers of amyloid pathology (CSF β-amyloid 42) and neurodegeneration (hippocampal volume on MRI and cortical metabolism on [18F]-fluorodeoxyglucose–PET) in 201 patients with MCI clinically followed for up to 6 years to detect progressive cognitive deterioration. We categorized patients with MCI as A+/A− and N+/N− based on presence/absence of amyloid pathology and neurodegeneration. SNAPs were A−N+ cases. Results: The proportion of progressors was 11% (8/41), 34% (14/41), 56% (19/34), and 71% (60/85) in A−N−, A+N−, SNAP, and A+N+, respectively; the proportion of APOE ε4 carriers was 29%, 70%, 31%, and 71%, respectively, with the SNAP group featuring a significantly different proportion than both A+N− and A+N+ groups (p ≤ 0.005). Hypometabolism in SNAP patients was comparable to A+N+ patients (p = 0.154), while hippocampal atrophy was more severe in SNAP patients (p = 0.002). Compared with A−N−, SNAP and A+N+ patients had significant risk of progressive cognitive deterioration (hazard ratio = 2.7 and 3.8, p = 0.016 and p < 0.001), while A+N− patients did not (hazard ratio = 1.13, p = 0.771). In A+N− and A+N+ groups, none of the biomarkers predicted time to progression. In the SNAP group, lower time to progression was correlated with greater hypometabolism (r = 0.42, p = 0.073). Conclusions: Our findings support the notion that patients with SNAP MCI feature a specific risk progression profile. PMID:25568301

  5. Antiretroviral monocyte efficacy score linked to cognitive impairment in HIV

    PubMed Central

    Shikuma, Cecilia M; Nakamoto, Beau; Shiramizu, Bruce; Liang, Chin-Yuan; DeGruttola, Victor; Bennett, Kara; Paul, Robert; Kallianpur, Kalpana; Chow, Dominic; Gavegnano, Christina; Hurwitz, Selwyn J; Schinazi, Raymond F; Valcour, Victor G

    2013-01-01

    Background Monocytes transmigrating to the brain play a central role in HIV neuropathology. We hypothesized that the continued existence of neurocognitive impairment (NCI) despite potent antiretroviral (ARV) therapy is mediated by the inability of such therapy to control this monocyte/macrophage reservoir. Methods Cross-sectional and longitudinal analyses were conducted within a prospectively enrolled cohort. We devised a monocyte efficacy (ME) score based on the anticipated effectiveness of ARV medications against monocytes/macrophages using published macrophage in vitro drug efficacy data. We examined, within an HIV neurocognitive database, its association with composite neuropsychological test scores (NPZ8) and clinical cognitive diagnoses among subjects on stable ARV medications unchanged for >6 months prior to assessment. Results Among 139 subjects on ARV therapy, higher ME score correlated with better NPZ8 performance (r=0.23, P<0.01), whereas a score devised to quantify expected penetration effectiveness of ARVs into the brain (CPE score) did not (r=0.12, P=0.15). In an adjusted model (adjusted r2=0.12), ME score (β=0.003, P=0.02), CD4+ T-cell nadir (β=0.001, P<0.01) and gender (β=−0.456, P=0.02) were associated with NPZ8, whereas CPE score was not (β=0.003, P=0.94). A higher ME score was associated with better clinical cognitive status (P<0.01). With a range of 12.5–433.0 units, a 100-unit increase in ME score resulted in a 10.6-fold decrease in the odds of a dementia diagnosis compared with normal cognition (P=0.01). Conclusions ARV efficacy against monocytes/macrophages correlates with cognitive function in HIV-infected individuals on ARV therapy within this cohort. If validated, efficacy against monocytes/macrophages may provide a new target to improve HIV NCI. PMID:23018140

  6. Is quality of life associated with cognitive impairment in schizophrenia?

    PubMed

    Alptekin, Köksal; Akvardar, Yildiz; Kivircik Akdede, Berna Binnur; Dumlu, Kemal; Işik, Doğan; Pirinçci, Ferdane; Yahssin, Saida; Kitiş, Arzu

    2005-02-01

    The subjectively assessed quality of life of schizophrenia patients is mostly lower than healthy subjects, and cognitive impairment is an integral feature of schizophrenia. The aims of the present study were to compare the quality of life and neurocognitive functioning between the patients with schizophrenia and the healthy subjects, and to examine the relationships between quality of life and neurocognitive functions among the patients with schizophrenia. Thirty-eight patients with schizophrenia (15 women and 23 men) and 31 healthy individuals (18 women and 13 men) were included in the study. All participants were administered World Health Organization Quality of Life-Brief Form (WHOQOL-BREF) to assess their quality of life, and Digit Span Test (DST) and Controlled Oral Word Association Test (COWAT) for cognitive functions. The patients with schizophrenia demonstrated lower scores in physical (F=25.6, p=0.0001), psychological (F=15.85, p=0.0001) and social (F=37.7, p=0.0001) domains compared to control group. The patients with schizophrenia showed significantly lower scores on COWAT compared to healthy subjects (F=4.22, p=0.04). The social domain scores of WHOQOL correlated to DST total scores (r=0.45, p=0.007), DST forwards scores (r=0.54, p=0.001) and COWAT total scores (r=0.40, p=0.04) in patients with schizophrenia but not in the control group. The patients with lower level of cognitive functioning had lower scores on social domain of WHOQOL-BREF (z=-2.01, p=0.04). Our results confirm that the cognitive deficits in executive function and working memory appear to have direct impact on the patients' perceived quality of life especially in social domain which can either be a cause or a consequence of social isolation of patients with schizophrenia.

  7. Studying nursing interventions in acutely ill, cognitively impaired older adults

    PubMed Central

    McCauley, Kathleen; Bradway, Christine; Hirschman, Karen B; Naylor, Mary D

    2015-01-01

    Background Between one and two of every five hospitalized older adults have cognitive deficits, often not accurately assessed or well managed. Cognitive impairment adds substantially to the complexity of these patients’ care, places them at high risk for poor outcomes and increases the cost of health care. Methods We describe three evidence-based interventions, each capitalizing on the unique contributions of nurses and designed to improve outcomes of hospitalized older adults who have cognitive deficits. Interventions of varying intensity were compared across three hospitals (Phase I) and subsequently within the same hospitals (Phase II). All enrolled patients were screened during their index hospitalizations and cognitive deficits were communicated to relevant health care team members (Augmented Standard Care-ASC, lowest intensity). At one hospital, ASC was the only intervention. Patients at a second hospital also had care influenced by specially prepared registered nurses (Resource Nurse Care-RNC, medium intensity). Finally, patients at third hospital also received advanced practice nurse coordinated care (Transitional Care Model-TCM, higher intensity). In Phase II, newly enrolled patients at these same hospitals all received the TCM. We summarize major themes from review of multiple data sources and researcher recollections related to facilitators and barriers to implementing a complex research study. Findings Effective implementation of the three intervention strategies depended on clinician engagement and communication; degree of participation by nurses in the educational program with subsequent practice improvement; and success of advanced practice nurses in implementing the TCM with both with patients, family caregivers and clinicians. Implications Based on lessons learned in implementing complex research studies within the “real world” of clinical practice settings, recommendations focus on strengthening facilitators, minimizing barriers and gaining

  8. Efficacy and safety of cognitive enhancers for patients with mild cognitive impairment: a systematic review and meta-analysis

    PubMed Central

    Tricco, Andrea C.; Soobiah, Charlene; Berliner, Shirra; Ho, Joanne M.; Ng, Carmen H.; Ashoor, Huda M.; Chen, Maggie H.; Hemmelgarn, Brenda; Straus, Sharon E.

    Background: Cognitive enhancers, including cholinesterase inhibitors and memantine, are used to treat dementia, but their effectiveness for mild cognitive impairment is unclear. We conducted a systematic review to examine the efficacy and safety of cognitive enhancers for mild cognitive impairment. Methods: Our eligibility criteria were studies of the effects of donepezil, rivastigmine, galantamine or memantine on mild cognitive impairment reporting cognition, function, behaviour, global status, and mortality or harms. We identified relevant material by searching electronic databases (e.g., MEDLINE, Embase), the references of included studies, trial registries and conference proceedings, and by contacting experts. Two reviewers independently screened the results of the literature search, abstracted data and appraised risk of bias using the Cochrane risk-of-bias tool. Results: We screened 15 554 titles and abstracts and 1384 full-text articles. Eight randomized clinical trials and 3 companion reports met our inclusion criteria. We found no significant effects of cognitive enhancers on cognition (Mini–Mental State Examination: 3 randomized clinical trials [RCTs], mean difference [MD] 0.14, 95% confidence interval [CI] −0.22 to 0.50; Alzheimer’s Disease Assessment Scale — cognition subscale: 3 RCTs, standardized MD −0.07, 95% CI−0.16 to 0.01]) or function (Alzheimer’s Disease Cooperative Study activities of daily living inventory: 2 RCTs, MD 0.30, 95% CI −0.26 to 0.86). Cognitive enhancers were associated with higher risks of nausea, diarrhea and vomiting than placebo. Interpretation: Cognitive enhancers did not improve cognition or function among patients with mild cognitive impairment and were associated with a greater risk of gastrointestinal harms. Our findings do not support the use of cognitive enhancers for mild cognitive impairment. PMID:24043661

  9. Computerized Cognitive Training in Older Adults With Mild Cognitive Impairment or Dementia: A Systematic Review and Meta-Analysis.

    PubMed

    Hill, Nicole T M; Mowszowski, Loren; Naismith, Sharon L; Chadwick, Verity L; Valenzuela, Michael; Lampit, Amit

    2017-04-01

    Previous meta-analyses indicate that computerized cognitive training (CCT) is a safe and efficacious intervention for cognition in older adults. However, efficacy varies across populations and cognitive domains, and little is known about the efficacy of CCT in people with mild cognitive impairment or dementia. The authors searched Medline, Embase, PsychINFO, CINAHL, and CENTRAL through July 1, 2016, for randomized controlled trials of CCT in older adults with mild cognitive impairment or dementia. Overall cognition, individual cognitive domains, psychosocial function, and activities of daily living were pooled separately for mild cognitive impairment and dementia trials. The overall effect on cognition in mild cognitive impairment across 17 trials was moderate (Hedges' g=0.35, 95% CI=0.20-0.51). There was no evidence of publication bias or difference between active- and passive-controlled trials. Small to moderate effects were found for global cognition, attention, working memory, learning, and memory, with the exception of nonverbal memory, and for psychosocial functioning, including depressive symptoms. In dementia, statistically significant effects were found on overall cognition (k=11, g=0.26, 95% CI=0.01-0.52) and visuospatial skills, but these were driven by three trials of virtual reality or Nintendo Wii. CCT is efficacious on global cognition, select cognitive domains, and psychosocial functioning in people with mild cognitive impairment. This intervention therefore warrants longer-term and larger-scale trials to examine effects on conversion to dementia. Conversely, evidence for efficacy in people with dementia is weak and limited to trials of immersive technologies.

  10. The PACE study: a randomised clinical trial of cognitive activity (CA) for older adults with mild cognitive impairment (MCI).

    PubMed

    Vidovich, Mandy R; Lautenschlager, Nicola T; Flicker, Leon; Clare, Linda; Almeida, Osvaldo P

    2009-12-14

    Research evidence from observational studies suggests that cognitive activity reduces the risk of cognitive impairment in later life as well as the rate of cognitive decline of people with dementia. The Promoting Healthy Ageing with Cognitive Exercise (PACE) study has been designed to determine whether a cognitive activity intervention decreases the rate of cognitive decline amongst older adults with mild cognitive impairment (MCI). The study will recruit 160 community-dwelling men and women aged 65 years of age or over with mild cognitive impairment (MCI). Participants will be randomly allocated to two treatment groups: non-specific education and cognitive activity. The intervention will consist of ten 90-minute sessions delivered twice per week over a period of five weeks. The primary outcome measure of the study is the change from baseline in the total score on the Cambridge Cognitive Score (CAMCOG). Secondary outcomes of interest include changes in memory, attention, executive functions, mood and quality of life. Primary endpoints will be collected 12, 52 and 104 weeks after the baseline assessment. The proposed project will produce the best available evidence on the merits of increased cognitive activity as a strategy to prevent cognitive decline among older adults with MCI. We anticipate that the results of this study will have implications for the development of evidence-based preventive strategies to reduce the rate of cognitive decline amongst older people at risk of dementia. ACTRN12608000556347.

  11. The PACE Study: A randomised clinical trial of cognitive activity (CA) for older adults with mild cognitive impairment (MCI)

    PubMed Central

    2009-01-01

    Background Research evidence from observational studies suggests that cognitive activity reduces the risk of cognitive impairment in later life as well as the rate of cognitive decline of people with dementia. The Promoting Healthy Ageing with Cognitive Exercise (PACE) study has been designed to determine whether a cognitive activity intervention decreases the rate of cognitive decline amongst older adults with mild cognitive impairment (MCI). Methods/Design The study will recruit 160 community-dwelling men and women aged 65 years of age or over with mild cognitive impairment (MCI). Participants will be randomly allocated to two treatment groups: non-specific education and cognitive activity. The intervention will consist of ten 90-minute sessions delivered twice per week over a period of five weeks. The primary outcome measure of the study is the change from baseline in the total score on the Cambridge Cognitive Score (CAMCOG). Secondary outcomes of interest include changes in memory, attention, executive functions, mood and quality of life. Primary endpoints will be collected 12, 52 and 104 weeks after the baseline assessment. Discussion The proposed project will produce the best available evidence on the merits of increased cognitive activity as a strategy to prevent cognitive decline among older adults with MCI. We anticipate that the results of this study will have implications for the development of evidence-based preventive strategies to reduce the rate of cognitive decline amongst older people at risk of dementia. Trial registration ACTRN12608000556347 PMID:20003398

  12. Differences in cognitive impairment between schizophrenia and bipolar disorder: Considering the role of heterogeneity.

    PubMed

    Bora, Emre

    2016-10-01

    Schizophrenia is associated with significant cognitive impairment. Bipolar disorder (BD) also presents with cognitive deficits that are similar to, albeit less severe, than those reported in schizophrenia. There has been controversy over whether selective deficits in social cognition or developmental trajectory of cognitive deficits can distinguish schizophrenia from BD. Also, available studies have not generally considered the potential effect of cognitive heterogeneity within the two disorders on between-group differences. The current review examines the evidence on the specificity of social cognitive deficits and early neurocognitive impairment to schizophrenia and explores the overall outcome of studies investigating within and cross-diagnosis cognitive heterogeneity in schizophrenia and BD. Current evidence does not support the specificity of social cognitive impairment to schizophrenia. Available studies also suggest that cognitive impairment in premorbid and early stages is evident not only in schizophrenia but also in many BD patients. Both schizophrenia and BD have a number of cognitive subgroups, including severe impairment, good functioning, and one or more selective or modest impairment clusters. While both disorders are represented in each cognitive subgroup, there are significant cross-diagnostic differences regarding prevalences of individuals belonging to the severe impairment and good functioning subgroups. Individuals with schizophrenia are much more likely to exhibit severe cognitive impairment than individuals with BD and good cognitive functioning is more often observed in BD patients than schizophrenia patients. Further identification of the neurobiological and genetic characteristics of the cognitive subgroups in major psychoses can improve the validity of diagnostic systems and can advance the development of personalized management approaches, including cognitive remediation.

  13. Cognitive impairment in patients with Fibromyalgia syndrome as assessed by the Mini-Mental State Examination

    PubMed Central

    2009-01-01

    Background This study evaluated the frequency of cognitive impairment in patients with Fibromyalgia syndrome (FMS) using the Mini Mental State Examination (MMSE). Methods We analyzed baseline data from all 46 patients with FMS and 92 age- and sex-matched controls per diagnosis of neuropathic (NeP) or mixed pain (MP) selected from a larger prospective study. Results FMS had a slight but statistically significant lower score in the adjusted MMSE score (26.9; 95% CI 26.7-27.1) than either NeP (27.3; 95% CI 27.2-27.4) or MP (27.3; 27.2-27.5). The percentage of patients with congnitive impairment (adjusted MMSE ≤ 26) was numerically higher in FMS (15%; 95% CI 6.3-29) compared with NeP (5%; 95% CI 1.8-12.2) or MP (5%; 95% CI 1.8-12.2) and higher than in the same age stratum of the general population (0.05%). Conclusions Compared with the population reference value, patients with FMS showed high frequency of cognitive impairment. PMID:20025750

  14. Different Characteristics of Cognitive Impairment in Elderly Schizophrenia and Alzheimer's Disease in the Mild Cognitive Impairment Stage

    PubMed Central

    Kazui, Hiroaki; Yoshida, Tetsuhiko; Takaya, Masahiko; Sugiyama, Hiromichi; Yamamoto, Daisuke; Kito, Yumiko; Wada, Tamiki; Nomura, Keiko; Yasuda, Yuka; Yamamori, Hidenaga; Ohi, Kazutaka; Fukumoto, Motoyuki; Iike, Naomi; Iwase, Masao; Morihara, Takashi; Tagami, Shinji; Shimosegawa, Eku; Hatazawa, Jun; Ikeda, Yoshiyuki; Uchida, Eiichi; Tanaka, Toshihisa; Kudo, Takashi; Hashimoto, Ryota; Takeda, Masatoshi

    2011-01-01

    We compared indices of the revised version of the Wechsler Memory Scale (WMS-R) and scaled scores of the five subtests of the revised version of the Wechsler Adult Intelligence Scale (WAIS-R) in 30 elderly schizophrenia (ES) patients and 25 Alzheimer's disease (AD) patients in the amnestic mild cognitive impairment (aMCI) stage (AD-aMCI). In the WMS-R, attention/concentration was rated lower and delayed recall was rated higher in ES than in AD-aMCI, although general memory was comparable in the two groups. In WAIS-R, digit symbol substitution, similarity, picture completion, and block design scores were significantly lower in ES than in AD-aMCI, but the information scores were comparable between the two groups. Delayed recall and forgetfulness were less impaired, and attention, working memory and executive function were more impaired in ES than in AD-aMCI. These results should help clinicians to distinguish ES combined with AD-aMCI from ES alone. PMID:22163230

  15. Semantic memory and depressive symptoms in patients with subjective cognitive decline, mild cognitive impairment, and Alzheimer's disease.

    PubMed

    Lehrner, J; Coutinho, G; Mattos, P; Moser, D; Pflüger, M; Gleiss, A; Auff, E; Dal-Bianco, P; Pusswald, G; Stögmann, E

    2017-07-01

    Semantic memory may be impaired in clinically recognized states of cognitive impairment. We investigated the relationship between semantic memory and depressive symptoms (DS) in patients with cognitive impairment. 323 cognitively healthy controls and 848 patients with subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer's disease (AD) dementia were included. Semantic knowledge for famous faces, world capitals, and word vocabulary was investigated. Compared to healthy controls, we found a statistically significant difference of semantic knowledge in the MCI groups and the AD group, respectively. Results of the SCD group were mixed. However, two of the three semantic memory measures (world capitals and word vocabulary) showed a significant association with DS. We found a difference in semantic memory performance in MCI and AD as well as an association with DS. Results suggest that the difference in semantic memory is due to a storage loss rather than to a retrieval problem.

  16. Cognitive impairments in poly-drug ketamine users.

    PubMed

    Liang, H J; Lau, C G; Tang, A; Chan, F; Ungvari, G S; Tang, W K

    2013-11-01

    Cognitive impairment has been found to be reversible in people with substance abuse, particularly those using ketamine. Ketamine users are often poly-substance users. This study compared the cognitive functions of current and former ketamine users who were also abusing other psychoactive substances with those of non-users of illicit drugs as controls. One hundred ketamine poly-drug users and 100 controls were recruited. Drug users were divided into current (n = 32) and ex-users (n = 64) according to the duration of abstinence from ketamine (>30 days). The Beck Depression Inventory (BDI), the Hospital Anxiety Depression Scale (HADSA) and the Severity of Dependence Scale (SDS) were used to evaluate depression and anxiety symptoms and the severity of drug use, respectively. The cognitive test battery comprised verbal memory (Wechsler Memory Scale III: Logic Memory and Word List), visual memory (Rey-Osterrieth Complex Figure, ROCF), executive function (Stroop, Wisconsin Card Sorting Test, and Modified Verbal Fluency Test), working memory (Digit Span Backward), and general intelligence (Information, Arithmetic and Digit-Symbol Coding) tests. Current users had higher BDI and HADSA scores than ex-users (p < 0.001 for BDI and p = 0.022 for HADSA) and controls (p < 0.001 for BDI and p = 0.002 for HADSA). Ex-users had higher BDI (p = 0.006) but equal HADSA scores (p = 1.000) compared to controls. Both current and ex-users had lower scores on Logical Memory delayed recall (p = 0.038 for current users and p = 0.032 for ex-users) and ROCF delayed recall (p = 0.033 for current users and p = 0.014 for ex-users) than controls. Current users also performed worse on ROCF recognition than controls (p = 0.002). No difference was found between the cognitive functions of current and ex-users. Ketamine poly-drug users displayed predominantly verbal and visual memory impairments, which persisted in ex-users. The interactive effect of ketamine and poly-drug use on memory needs further

  17. Modeling of cognitive impairment by disease duration in multiple sclerosis: a cross-sectional study.

    PubMed

    Achiron, Anat; Chapman, Joab; Magalashvili, David; Dolev, Mark; Lavie, Mor; Bercovich, Eran; Polliack, Michael; Doniger, Glen M; Stern, Yael; Khilkevich, Olga; Menascu, Shay; Hararai, Gil; Gurevich, Micharel; Barak, Yoram

    2013-01-01

    Large-scale population studies measuring rates and dynamics of cognitive decline in multiple sclerosis (MS) are lacking. In the current cross-sectional study we evaluated the patterns of cognitive impairment in MS patients with disease duration of up to 30 years. 1,500 patients with MS were assessed by a computerized cognitive battery measuring verbal and non-verbal memory, executive function, visual spatial perception, verbal function, attention, information processing speed and motor skills. Cognitive impairment was defined as below one standard deviation (SD) and severe cognitive impairment as below 2SD for age and education matched healthy population norms. Cognitive performance in our cohort was poorer than healthy population norms. The most frequently impaired domains were information processing speed and executive function. MS patients with secondary-progressive disease course performed poorly compared with clinically isolated syndrome, relapsing-remitting and primary progressive MS patients. By the fifth year from disease onset, 20.9% of patients performed below the 1SD cutoff for impairment, p=0.005, and 6.0% performed below the 2SD cutoff for severe cognitive impairment, p=0.002. By 10 years from onset 29.3% and 9.0% of patients performed below the 1SD and 2SD cutoffs, respectively, p=0.0001. Regression modeling suggested that cognitive impairment may precede MS onset by 1.2 years. The rates of cognitive impairment in this large sample of MS patients were lower than previously reported and severe cognitive impairment was evident only in a relatively small group of patients. Cognitive impairment differed significantly from expected normal distribution only at five years from onset, suggesting the existence of a therapeutic window during which patients may benefit from interventions to maintain cognitive health.

  18. Test accuracy of cognitive screening tests for diagnosis of dementia and multidomain cognitive impairment in stroke.

    PubMed

    Lees, Rosalind; Selvarajah, Johann; Fenton, Candida; Pendlebury, Sarah T; Langhorne, Peter; Stott, David J; Quinn, Terence J

    2014-10-01

    Guidelines recommend screening stroke-survivors for cognitive impairments. We sought to collate published data on test accuracy of cognitive screening tools. Index test was any direct, cognitive screening assessment compared against reference standard diagnosis of (undifferentiated) multidomain cognitive impairment/dementia. We used a sensitive search statement to search multiple, cross-disciplinary databases from inception to January 2014. Titles, abstracts, and articles were screened by independent researchers. We described risk of bias using Quality Assessment of Diagnostic Accuracy Studies tool and reporting quality using Standards for Reporting of Diagnostic Accuracy guidance. Where data allowed, we pooled test accuracy using bivariate methods. From 19 182 titles, we reviewed 241 articles, 35 suitable for inclusion. There was substantial heterogeneity: 25 differing screening tests; differing stroke settings (acute stroke, n=11 articles), and reference standards used (neuropsychological battery, n=21 articles). One article was graded low risk of bias; common issues were case-control methodology (n=7 articles) and missing data (n=22). We pooled data for 4 tests at various screen positive thresholds: Addenbrooke's Cognitive Examination-Revised (<88/100): sensitivity 0.96, specificity 0.70 (2 studies); Mini Mental State Examination (<27/30): sensitivity 0.71, specificity 0.85 (12 studies); Montreal Cognitive Assessment (<26/30): sensitivity 0.95, specificity 0.45 (4 studies); MoCA (<22/30): sensitivity 0.84, specificity 0.78 (6 studies); Rotterdam-CAMCOG (<33/49): sensitivity 0.57, specificity 0.92 (2 studies). Commonly used cognitive screening tools have similar accuracy for detection of dementia/multidomain impairment with no clearly superior test and no evidence that screening tools with longer administration times perform better. MoCA at usual threshold offers short assessment time with high sensitivity but at cost of specificity; adapted cutoffs have improved

  19. Mild cognitive impairment: making headway by stepping backwards.

    PubMed

    Förstl, Hans; Lautenschlager, Nicola; Bickel, Horst

    2003-01-01

    Mild cognitive impairment (MCI) is a prevalent medical problem and the concept and term have become a catch-phrase for research and clinical practice. However, little is known about the most effective tools for a clinical diagnosis of MCI, its potential significance for individual patients and the best possible intervention--at least as long as MCI is considered as a diagnostic entity. We propose a simplified diagnostic and interventional algorithm for the detection and management of patients with MCI. We argue that MCI is so important, because it represents the closest call for an identification of treatable diseases or risk factors before the final manifestation of irreversible brain changes. Stepping backward by focussing on underlying disease processes and attempting causal interventions must be preferred to a mere symptomatic treatment of MCI as a preclinical form of Alzheimer's disease.

  20. Marital Quality in the Context of Mild Cognitive Impairment

    PubMed Central

    Garand, Linda; Dew, Mary Amanda; Urda, Bridget; Lingler, Jennifer Hagerty; DeKosky, Steven T.; Reynolds, Charles F.

    2010-01-01

    The behavioral changes in people with dementia often negatively affect marital relationships. Yet little is known about how the marital relationship is affected when the care recipient has mild cognitive impairment (MCI). This study characterizes marital quality among adults who live with a spouse with MCI. Data were drawn from interviews with 27 spouses of people with a recent diagnosis of MCI. Even at early stages of MCI, many spouses report the frequent occurrence of distressing behaviors. This study demonstrates that MCI may degrade the quality of the marital relationship. These results have implications for clinical practice and the delivery of health care and social services to these families. It is important to develop interventions to address the needs of these individuals and their caregivers. Results of this study suggest the need for mental health interventions designed to preserve the quality of these marital relationships. PMID:17984481

  1. Effects of alternative interventions among hospitalized, cognitively impaired older adults

    PubMed Central

    Naylor, Mary D; Hirschman, Karen B; Hanlon, Alexandra L; Bowles, Kathryn H; Bradway, Christine; McCauley, Kathleen M; Pauly, Mark V

    2016-01-01

    Aim: Compare within site effects of three interventions designed to enhance outcomes of hospitalized cognitively impaired elders. Methods: Prospective, nonrandomized, confirmatory phased study. In Phase I, 183 patients received one of three interventions: augmented standard care (ASC), resource nurse care (RNC) or Transitional Care Model (TCM). In Phase II, 205 patients received the TCM. Results: Time to first rehospitalization or death was longer for the TCM versus ASC group (p = 0.017). Rates for total all-cause rehospitalizations and days were significantly reduced in the TCM versus ASC group (p < 0.001, both). No differences were observed between RNC versus TCM. Conclusion: Findings suggest the TCM is more effective than ASC. However, potential effects of the RNC relative to the TCM warrant further study. PMID:27146416

  2. Review of emotion recognition in mild cognitive impairment.

    PubMed

    McCade, Donna; Savage, Greg; Naismith, Sharon L

    2011-01-01

    While dysfunction in emotion recognition is sometimes apparent with aging, and is frequently evident in Alzheimer's disease, it is unclear whether individuals who have a high risk of developing dementia exhibit demonstrable changes. A review of the literature pertaining to mild cognitive impairment was undertaken to discern the extent to which emotion recognition deficits are evident in this prodromal period. A search of Medline, Psycinfo and Psyextra databases using specific key words identified only six relevant studies. These studies suggest that the ability to accurately identify facial expressions of affect is compromised. Research in this area is in its infancy. Suggestions are made for furthering our knowledge about this important ability which affects interpersonal relationships, daily functioning, mental well-being and quality of life. Copyright © 2012 S. Karger AG, Basel.

  3. Differential Patterns of Hypoperfusion in Subtypes of Mild Cognitive Impairment

    PubMed Central

    Caffarra, Paolo; Ghetti, Caterina; Concari, Letizia; Venneri, Annalena

    2008-01-01

    In this study the regional cerebral blood flow (rCBF) pattern of three Mild Cognitive Impairment (MCI) subtypes was measured with SPECT in 60 patients (nineteen with an amnestic deficit, sixteen with disexecutive deficits, and twenty five with mild multidomain deficits) and compared with that of 15 healthy matched older adults. The amnestic MCI subgroup showed significant hypoperfusion in the left hippocampus, parahippocampal gyrus and fronto-parie