Dexmedetomidine alleviates cognitive dysfunction induced by tibial fracture in rats / 南方医科大学学报

OBJECTIVE@#To study the effect of dexmedetomidine (Dex) on cognitive dysfunction induced by tibial fracture in rats.@*METHODS@#Sixteen male SD rats were randomized into control group and tibial fracture group, and the behavior indicators were measured on days 1, 3, 5 and 7 after tibial fracture and the expressions of CX3L1 protein and mRNA in the hippocampus were detected. Another 24 male SD rats were randomly divided into control group, tibial fracture group, and tibia fracture with CX3CL1 antibody group, and the behavior indicators and hippocampal CX3L1 protein expression were evaluated after corresponding treatments. In another experiment, we randomized 24 male SD rats into control group, tibial fracture group and tibial fracture with Dex treatment, and tested their hippocampal CX3L1 protein and mRNA expressions as well as the behavior indicators after the treatments.@*RESULTS@#Compared with the control rats, the rats with tibial fracture spent significantly less time in the novel arm on days 1, 3, 5 and 7 after the fracture ( < 0.05) with obviously lowered expressions of CX3L1 protein and mRNA in the hippocampus ( < 0.05). In the rats with tibial fracture, treatment with CX3CL1 antibody further decreased the time spent in the novel arm ( < 0.05) and the expression level of CX3L1 protein in the hippocampus ( < 0.05); In contrast, treatment with Dex significantly increased the time spent time in the novel arm ( < 0.05) and enhanced the hippocampal expressions of CX3L1 protein and mRNA in rats with tibial fractures ( < 0.05).@*CONCLUSIONS@#Dex can alleviate cognitive dysfunction induced by tibial fracture in rats by increasing the expression of CX3CL1 in the hippocampus.

Evaluation of cognitive impairment in patients with episodic migraine / Avaliação do comprometimento cognitivo em pacientes com migrânea episódica

ABSTRACT BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the presence of cognitive deficits in patients with episodic migraine and control group, and to compare with the results previously described in the literature. METHODS: Patients with episodic migraine were included according to the International Headache Society criteria, and a control group was selected, matched by sex, age, and schooling. Patients were asked about the frequency and intensity of headaches, medications used, and comorbidities. Afterwards, a neuropsychological assessment was applied using the Montreal Cognitive Assessment, the clock drawing test, the verbal fluency test, and the Stroop test. The main variables influencing cognitive dysfunctions were analyzed (depressive disorder, anxiety disorder, sleep disorder, use of medication). RESULTS: Thirty patients with episodic migraine and 30 controls were evaluated. Patients with episodic migraine had a performance in the Montreal Cognitive Assessment test (p=0.53), the clock drawing test (p=0.80), the verbal fluency test (p=0.44) and the Stroop test (p=0.97) similar to the control group. Patients with chronic migraine (30 patients and 30 controls) performed a Montreal Cognitive Assessment test (p=0.00), verbal fluency test (p=0.00) and Stroop test (p=0.00) lower than the group control. The main variables influencing cognitive disorders were studied by linear regression, and none of these variables was an influencing factor in the Montreal Cognitive Assessment test. CONCLUSION: Patients with episodic migraine did not present cognitive deficits compared to a control group.

RESUMO JUSTIFICATIVA E OBJETIVOS: A proposta deste estudo foi avaliar a presença de déficits cognitivos em pacientes com migrânea episódica e grupo controle, e comparar com os resultados previamente descritos na literatura. MÉTODOS: Foram incluídos pacientes com migrânea episódica, segundo os critérios da International Headache Society, e selecionado um grupo controle pareado por sexo, idade e escolaridade. Os pacientes foram questionados sobre a frequência e intensidade de crises, fármacos, comorbidades. Posteriormente, foi realizada a avaliação neuropsicológica através do Montreal Cognitive Assessment, do teste do relógio, teste da fluência verbal e Stroop teste. As principais variáveis influenciadoras de distúrbios cognitivos foram analisadas (transtorno depressivo, transtorno de ansiedade, distúrbios do sono, uso de fármacos). RESULTADOS: Foram avaliados 30 pacientes com migrânea episódica e 30 controles. Os pacientes com migrânea episódica apresentaram uma performance no Montreal Cognitive Assessment teste (p=0,53), teste do relógio (p=0,80), teste da fluência verbal (p=0,44) e Stroop teste (p=0,97) semelhante ao grupo controle. Pacientes com enxaqueca crônica (30 pacientes e 30 controles) realizaram um teste de Montreal Cognitive Assessment teste (p=0,00), teste de fluência verbal (p=0,00) e teste de Stroop (p=0,00) menor que o grupo controle. As principais variáveis influenciadoras de distúrbios cognitivos foram estudadas através de regressão linear e nenhuma dessas variáveis apresentou-se como fator de influência no Montreal Cognitive Assessment. CONCLUSÃO: Os pacientes com migrânea episódica não apresentaram déficits cognitivos em comparação com um grupo controle.

Effect of preoperative statin therapy on early postoperative memory impairment after off‑pump coronary artery bypass surgery.

Context: Frequent incidence of early postoperative memory impairment (POMI) after cardiac surgery remains a concern because of associated morbidity, impaired quality of life, and increased health care cost. Aim: To assess the effect of preoperative statin therapy on POMI in patients undergoing off‑pump coronary artery bypass (OPCAB) surgery. Setting and Design: Prospective observational study in a tertiary level hospital. Methods: Sixty patients aged 45–65 years undergoing OPCAB surgery were allocated into two groups of 30 each. Group A patients were receiving statin and Group B patients were not receiving statins. All patients underwent memory function assessment preoperatively after admission to hospital and on the 6th postoperative day using postgraduate institute memory scale. Statistical Analysis: Appropriate tests were applied with SPSS 20 to compare both groups. The value P < 0.05 was considered statistically significant. Multiple regression analysis was performed with confounding factors to determine the effect on memory impairment. Results: Patients in Group A showed significant postoperative deterioration in 6 of the 10 functions and in Group B showed deterioration in 9 of 10 functions tested compared to preoperative scores. Intergroup comparison detected less POMI in Group A compared to Group B and was statistically significant in 8 memory functions. Multiple regression analysis detected statin as an independent factor in preventing memory impairment. Conclusions: Preoperative statin therapy attenuates the early POMI in patients undergoing OPCAB. Future long‑term studies will define the efficacy of statin on POMI.

Cognitive deficits in multiple sclerosis: a systematic review / Déficits cognitivos na esclerose múltipla: uma revisão sistemática

OBJECTIVE: To present the results of prospective and retrospective studies on multiple sclerosis patients cognitive dysfunctions, as well as to discuss the batteries of neuropsy- chological tests used in these investigations. METHOD: A systematic review was performed involving 40 studies published from 1997 to 2009, in PubMed, Scopus, Ovid, ISI Web of Knowledge, Scientific Electronic Library on line (Scielo) and Latin-American and Caribbean Center of Health Sciences Informations database. Clear description of multiple sclerosis patients cognitive deficits evaluation, study design, sample size; inclusion-exclusion and discontinuation criteria; instruments for neuropsychological evaluation, diagnostic methods, evaluated functions and detailed statistical analysis had been the inclusion criteria. RESULTS: There is consensus on cognitive impairment of multiple sclerosis patients, especially on memory, speed processing, executive function, attention and concentration domains. One has identified use of 23 batteries and 74 neuropsychological tests, despite the recommendation of Consortium of Multiple Sclerosis Centers to the application of MACFIMS battery. CONSIDERATIONS: The absence of the uniformization for multiple sclerosis patients cognitive evaluation battery has precluded to achieve evidences to recommend its incorporation on diagnostic routine. Nevertheless this tendency is already outlined.

OBJETIVO: Apresentar os resultados de estudos prospectivos e retrospectivos sobre disfunções cognitivas em pacientes com esclerose múltipla, assim como discutir as baterias de testes neuropsicológicos empregadas em tais investigações. MÉTODO: Uma revisão sistemática foi realizada envolvendo 40 estudos publicados no período de 1997 a 2009, nas bases de dados PubMed, Scopus, Ovid, ISI Web of Knowledge, Scientific Electronic Library on line (Scielo) e Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde. Descrição clara de: avaliação de déficits cognitivos em pacientes com esclerose múltipla, desenho do estudo, tamanho amostral, critérios de inclusão, exclusão e descontinuação, instrumentos de avaliação neuropsicológica, métodos diagnósticos, funções avaliadas e detalhamento da análise estatística foram critérios de inclusão. RESULTADOS: Há consenso quanto ao comprometimento cognitivo de pacientes com esclerose múltipla, especialmente nos domínios de memória, velocidade de processamento, função executiva, atenção e concentração. Identificou-se o emprego de 23 baterias e 74 testes neuropsicológicos, apesar da recomendação do Consórcio de Centros de esclerose múltipla para emprego da bateria MACFIMS. CONSIDERAÇÕES: A falta de uniformização da bateria de avaliação cognitiva desses pacientes está impedindo que se obtenham evidências para recomendar sua incorporação como rotina diagnóstica. Mesmo assim essa tendência já se delineia.

Disfunciones cognitivas posoperatorias del adulto mayor

Se ha realizado una revisión del tema de disfunciones cognitivas posoperatorias del adulto mayor. El interés del tema está dado por el aumento de la cirugía en pacientes de edad avanzada, con un aumento de la morbimortalidad y de los gastos en salud. Se ha analizado el concepto de reserva funcional y su importancia, así como los cambios fisiológicos que se suceden en los distintos parénquimas durante este período etario, tratando de relacionar a éstos con la capacidad de adaptación de los ancianos. Se hizo una revisión sobre las funciones cognitivas, y se clasificaron las mismas, tratando de establecer factores de riesgo, teniendo especial atención durante el período perioperatorio en estos pacientes. Se han clasificado también en cuanto al cuadro clínico de aparición (con causa o sin causa aparente) y a la relación temporal de aparición frente a la cirugía. Finalmente se establecieron pautas posibles de prevención y/o tratamiento.

summary An update concerning postoperative dysfunctions in elderly people is presented. The increment of surgery in that population, the greatest morbidity and mortality, and the increase in costs, makes this subject interesting. The effects of aging on different systems of the body, as well as the aspects of functional capacity reserve are analyzed. We also reviewed and classified the cognitive dysfunctions. It was one of the interest of this paper trying to point out risk factors, emphasizing the perioperative period. The classification take into account the clinical appearance of the dysfunction and its relation to the time of surgery. General recommendations of possible prevention and treatment are presented.

resumo Foi realizada uma revisão do tema de disfunções cognitivas pós-operatórias do paciente idoso. O interesse do tema se dá pêlo aumento do número de cirurgias em pacientes em idade avançada, com um aumento da morbimortalidade e dos gastos em saúde. Foi analisado o conceito de reserva funcional e sua importância, assim como as trocas fisiológicas que se sucedem nos distintos parênquimas nesta faixa etária,tratando de relacionar a estes, com a capacidade de adaptação dos idosos. Foi feita uma revisão sobre as funções cognitivas, e foram classificadas as mesmas, tratando de estabelecer fatores de risco, tendo especial atenção durante o período perioperatório nestes pacientes. Foi feita uma classificação também quanto ao quadro clínico de aparição (com causa ou sem causa aparente), e a relação temporal de aparição frente a cirurgia. Finalmente se estabeleceu pautas possíveis de prevenção e ou tratamento.

Neuropsychology and PET Findings of Corticobasal Degeneration

BACKGROUND: Corticobasal degeneration (CBD) is a rare neurodegenerative disorder involving the cortical and subcortical areas enabling it to cause abnormalities of both cognition and movement. In some reports, CBD has been known to develop variable degrees of intellectual, memory and language impairment. However, detailed neuropsychological assessments of CBD up to now have been few. We conducted a detailed neuropsychological investigation and FDG-PET to delineate the pattern of neuropsychological dysfunction of CBD and to correlate neuropsychological dysfunction with FDG-PET findings. METHODS: All 6 patients (5; right handedness, 1; left handedness) were diagnosed with CBD using clinical criteria. All the patients underwent detailed neuropsychological and brain FDG-PET tests. RESULTS: Neuropsychological tests showed multiple cognitive dysfunctions with moderate memory impairment. FDG-PET scans showed asymmetric decreased metabolism in bilateral fronoto-temporo-parietal cortical and subcortical areas. The extent of asymmetricity was greater on the subcortical than cortical areas. Unlike previous reports, the medial temporal and fronto-parietal metabolisms were similarly depressed. CONCLUSIONS: All CBD patients displayed prominent deficits on mostly cognitive domains. FDG-PET may explain the relation between cognitive dysfunctions and cortical hypometabolism and help differentiate CBD with other dementing disorders.

Cognitive Dysfunctions in Patients with Obsessive-Compulsive Disorder: Two-Year Treatment Follow-up / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the changes of cognitive dysfunctions in patients with obsessive compulsive disorder (OCD) over the two-year of pharmacological treatment. METHODS: The thirty-three OCD patients and thirteen normal subjects were administered the neuropsychological tests and clinical evaluations twice (at the baseline and two-year). RESULTS: In spite of the two-year treatment, the accuracy of delayed recall on the Rey-Osterrieth Complex Figure Tests (RCFT), the numbers of responses on the category and letter test of Controlled Oral Word Association Test (COWA), the response time on the Trail Making Test part A (TMT-A) remained significantly impaired in the OCD patients compared with the normal controls. CONCLUSION: These findings suggest that the cognitive dysfunctions such as visuospatial memory and verbal fluency might be the underlying persisting neuropathophysiology of OCD.

Cognitive Dysfunctions in Patients with Obsessive-Compulsive Disorder: Two-Year Treatment Follow-up / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the changes of cognitive dysfunctions in patients with obsessive compulsive disorder (OCD) over the two-year of pharmacological treatment. METHODS: The thirty-three OCD patients and thirteen normal subjects were administered the neuropsychological tests and clinical evaluations twice (at the baseline and two-year). RESULTS: In spite of the two-year treatment, the accuracy of delayed recall on the Rey-Osterrieth Complex Figure Tests (RCFT), the numbers of responses on the category and letter test of Controlled Oral Word Association Test (COWA), the response time on the Trail Making Test part A (TMT-A) remained significantly impaired in the OCD patients compared with the normal controls. CONCLUSION: These findings suggest that the cognitive dysfunctions such as visuospatial memory and verbal fluency might be the underlying persisting neuropathophysiology of OCD.

Study on Cognitive dysfunction of the major depression in Elderly by P300 / 中华物理医学与康复杂志

Objective To explore the detection methods for cognitive dysfunction of the major depression in Elderly and analyze their clinical significance.Methods Using matched-pairs study,42 patients with seniie de- pressive disorders(experimental group)and 42 normal aged people(control group)were examined with auditory e- voked potential P300(event related potential,ERP-P300)and SECF,respectively.Results It was found that the scores with registration,span,recall,classification and total score of the subjects in the experimental group were sig- nificantly lower than those in the control group(P