White matter lesions and Parkinson disease / 中华行为医学与脑科学杂志

White matter lesions (WMLs) are the extensive damage of periventricular and subcortical white matter caused by different etiology.Previous studies have shown that WMLs is associated with cognitive function, motor function, mood and urination function.Parkinson disease (PD) is a common chronic degenerative disease of the central nervous system.Recently, evidences showed that PD patients have a high susceptibility to WMLs which participates in the progression of motor and cognitive impairment.PD patients have higher risk of WMLs because of cardiovascular autonomic nerve dysfunction, long-term dopamine (DA) treatment and β-amyloid peptides (Aβ) deposition along vessels.Furthermore, recently, more and more evidences showed that WMLs could impact on the motor and cognitive symptoms of PD.WMLs had a significant influence on axial motor symptoms, and was related to executive function, attention, memory, visual-spatial ability and other cognitive impairment.Moreover, the severity of WMLs affects drug and surgical efficacy of patients with PD.Taking active measures to slacken the WMLs progression of PD will contribute to improve symptoms and curative effect.This article summarized the roles of WMLs in the occurrence and development of PD, in order to provide theoretical basis for prevention, diagnosis and treatment of PD.

Effects of typical or atypical antipsychotics on cognitive symptoms of the patients with schizophrenia / 上海交通大学学报（医学版）

Objective: To compare the effects of long-term use of typical and atypical antipsychotics on cognitive symptoms of the patients with schizophrenia. Methods: One hundred and two long-term inpatients with schizophrenia in Shanghai Jinshan Mental Health Center were included. According to the types of antipsychotics, the inpatients were divided into typical antipsychotics treatment group (typical group) or atypical antipsychotics treatment group (atypical group) with 51 cases each. Mental symptoms were evaluated by Positive and Negative Symptom Scale (PANSS), and cognitive symptoms were evaluated by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Results: Ninety-nine patients completed the investigation (49 cases in typical group and 50 cases in atypical group). PANSS score: the negative symptom score in the atypical group was lower than that in the typical group, and the difference was statistically significant (P=0.049). RBANS score: The total score of RBANS and the scores of immediate memory, language, attention and delayed memory in the atypical group were significantly higher than those in the typical group (all P<0.05). Conclusion: Compared with the patients who take typical antipsychotics, the patients with schizophrenia who take atypical antipsychotics for a long time have better cognitive symptom scores.

Relação entre qualidade do sono e funções cognitivas em pacientes com doença de Parkinson / Relación entre la calidad del sueño y función cognitiva en pacientes con la enfermedad de Parkinson / Relationship between quality of sleep and cognitive function in patients with Parkinsons disease

Descrever as características clínicas e demográficas de pacientes com Doença de Parkinson, bem como verificar a relação entre a qualidade do sono e as funções cognitivas. Trata-se de um estudo descritivo-analítico de corte transversal em que foram avaliados episódios de depressão, ansiedade, estado geral e progressão da doença, sonolência, qualidade do sono e funções cognitivas de 24 pacientes com Doença de Parkinson sem demência. Analisando os resultados do teste de memória tardia e a as alterações do sono, encontrou-se correlação do tipo inversa e moderada. O componente latência do sono teve uma correlação inversa e moderada com a memória, e também com a função visuoespacial. Outras relações também foram observadas como entre a qualidade subjetiva do sono e a função visuoespacial, a latência do sono e o resultado global do SCOPA-COG, e entre a duração do sono e a atenção. Todas essas correlações foram inversas e de caráter fraco. Esse estudo sugere que os déficits cognitivos leves, na ausência de demência, foram relacionados com qualidade ruim do sono.

Describir las características clínicas de pacientes con la enfermedad de Parkinson, así como la relación entre la calidad del sueño y las funciones cognitivas. Se realizó un estudio descriptivo-analítico de corte transversal que evaluó: los episodios de depresión, ansiedad, estado de salud general, progresión de la enfermedad, sueño, calidad del sueño y funciones cognitivas de 24 pacientes con enfermedad de Parkinson sin demencia. Se observó una relación inversa de tipo moderada entre la memoria tardía y trastornos del sueño. El componente de la latencia del sueño tuvo una correlación inversa moderada con la memoria, y con la función visuoespacial. También se observaron otras relaciones entre la calidad subjetiva del sueño y la función visuoespacial, la latencia del sueño y el resultado global de la SCOPA-COG, y entre la duración del sueño y la atención. Se observó que estas correlaciones fueron inversas y de carácter débil. Este estudio sugiere que los déficits cognitivos leves en ausencia de demencia se relacionaron con la mala calidad del sueño.

Here, we describe the clinical characteristics of patients with Parkinson's disease, as well as study the relationship between sleep quality and cognitive functions. This is a descriptive-analytical cross-sectional study in which we evaluate episodes of depression and anxiety, as well as the state of general health, disease progression, sleepiness, sleep quality and cognitive functions of 24 patients with Parkinson's disease without dementia. We found a moderate inverse correlation between memory and sleep disturbances, and a moderate inverse correlation of memory and visuospatial function. We also observed other associations between subjective sleep quality and visuospatial function, sleep latency and the overall result of the SCOPA-COG, and between sleep duration and attention; all of these correlations were inverse and weak. This study suggests that mild cognitive deficits in the absence of dementia are associated with poor sleep quality.

Revisión de dos instrumentos de simulación neurocognitiva y su utilidad en el contexto forense / Review of the neurocognitive malingering instrument and its useful in a forensic contex

Gran parte de la precisión de la evaluación neuropsicológica, depende que los instrumentos que utiliza, sean medidas estandarizadas, válidas y confiables. Sin embargo, la simulación, la exageración y el bajo esfuerzo son aspectos que pueden interferir en los resultados de los test. El objetivo de esta revisión pretende describir y analizar dos instrumentos en el contexto de la Neuropsicología Forense que evalúan simulación de síntomas cognitivos: el Test of Memory Malingering (TOMM) y el Victoria Symptoms Validity Test (VSVT). Se realizó una búsqueda dirigida no exhaustiva, en diversas bases de datos y libros afines. El criterio de inclusión fue la utilización o revisión de los test. Se seleccionaron 68 trabajos publicados. Cada uno de los cuales fue analizado en base a las características técnicas de los instrumentos. La revisión ha demostrado que el TOMM y el VSVT son instrumentos pertinentes para valorar simulación y exageración de sintomatología cognitiva. Estos instrumentos cuentan con un cúmulo de investigaciones que avalan sus propiedades, pero también las limitaciones y restricciones de su utilización.

Most of the accuracy in neuropsychological assessment depends that the instruments used are standardized, valid and reliable measures. However, malingering, exaggeration and poor effort are aspects that can interfere with the interpretation of the results. The aim of this review was to describe and analyze two instruments in the context of forensic neuropsychology that assess malingering of cognitive symptoms: Test of Memory Malingering (TOMM) and Victoria Symptoms ValidityTest (VSVT). Several scientific databases and related books were searched non-exhaustively. The criterion for inclusion in this review was the use of test. We selected 68 documents, each one was analyzed based on the technical characteristics of the instruments. Review showed that the TOMM and VSVT are relevant instruments for assessing malingering and exaggeration of cognitive symptoms. These instruments have several evidence that support their psychometric properties but also limitations and restrictions on their use.

Association between Cognitive Subdomains and Extrapyramidal Signs in Alzheimer Disease: A Clinical Research Center for Dementia of South Korea (CREDOS) Study

OBJECTIVES: We aimed to investigate the prevalence of Extrapyramidal signs (EPS) and the associations between EPS and cognitive subdomains in patients with Alzheimer disease (AD). METHODS: We recruited 1,324 patients with AD from the Clinical Research of Dementia of South Korea (CREDOS), a hospital based cohort study with fifty-six participating hospitals. We estimated cognitive subdomain using the Seoul Neuropsychological Screening Battery-Dementia version (SNSB-D). Dementia severity was measured by Clinical Dementia Rating Sum of Boxes (CDR-SB) and Korean version of Mini-Mental Status Examination (K-MMSE). The EPS group was defined by the presence of at least one EPS based on a focused neurologic examination. RESULTS: The prevalence of patients with EPS was 11%. These had higher CDR-SB scores than non-EPS group. After controlling for demographic, radiological, and dementia severity (CDR-SB) factors, EPS group showed lower cognitive ability in the subdomains for visuospatial and frontal-executive function than non-EPS group. The patients with EPS were showed significantly higher scores in the subdomain for memory function. CONCLUSION: The presence of EPSs in patients with AD was associated with lower visuospatial, frontal-executive function and higher memory function.

Norms for the mini-mental state examination: adjustment of the cut-off point in population-based studies (evidences from the Bambuí health aging study) / Normas para o uso do mini-exame do estado mental: adequação do ponto de corte em estudos populacionais (evidências do Projeto Bambuí)

OBJECTIVE: To estimate the prevalence of cognitive impairment in an elderly population-based cohort, using several Mini-Mental State Examination (MMSE) cut-off points recommended by Brazilian authors and to examine the percentile distribution of MMSE scores in the study population. METHOD: A total of 1558 subjects aged >60 years (89.4 percent of the total), living in the city of Bambuí, MG, completed the MMSE and were included in the present study. RESULTS: The estimated prevalences of cognitive impairment varied from 13.2 percent to 27.0 percent depending on the cut-off point and agreement varied widely between them (kappa range: 0.38 to 0.88). Cut-off point 13/14 corresponded to the 5th percentile and 21/22 corresponded to the lower quartile of the MMSE score distribution. CONCLUSION: In the absence of comparable cut-off points, percentile distributions are more adequate for population-based studies of elderly with low schooling level.

OBJETIVO: Estimar a prevalência de déficit cognitivo em uma base populacional de idosos, utilizando-se os diferentes pontos de corte do Mini-Exame do Estado Mental (MEEM) recomendados por autores brasileiros e verificar a distribuição em percentis da pontuação do MEEM na população estudada. MÉTODO: Participaram do estudo 1558 (89,4 por cento do total) indivíduos com idade >60 anos residentes na cidade de Bambuí, MG, que foram submetidos ao MEEM. RESULTADOS: A prevalência estimada de déficit cognitivo variou de 13,2 por cento a 27,0 por cento, dependendo do ponto de corte utilizado, observando-se grande variação na sua concordância (índices de kappa entre 0,38 e 0,88). O ponto de corte de 13/14 correspondeu ao 5º percentil e o de 21/22, ao quartil inferior da distribuição dos escores do MEEM. CONCLUSÃO: Na ausência de pontos de corte comparáveis, a distribuição em percentis é mais adequada para estudos de base populacional de idosos com baixa escolaridade.

Revisión actualizada de la relación BDNF, cognición y esquizofrenia/psicosis / BDNF, cognition and schizophrenia/psychosis: an updated review

El Factor Neurotrófico Derivado del Cerebro (BDNF) se ha relacionado con los síntomas cognitivos de la esquizofrenia, lo que se ha documentado en revisiones previas. Sin embargo, recientemente el foco de la investigación neurobiológica ha pasado de estudiar la esquizofrenia como enfermedad a estudiar las psicosis como grupo. El objetivo de esta investigación fue realizar una revisión actualizada de las publicaciones de los últimos cinco años (2013 a 2018) respecto a BDNF y síntomas cognitivos, tanto en esquizofrenia como en psicosis en general. Para esto se revisaron en PubMed los artículos con las palabras clave BDNF, cognitive y schizophrenia, y luego se repitió este proceso con la palabra psychosis. Como resultado, en el desarrollo del artículo se describe la manera en que distintos estudios, tanto en seres humanos como en modelos animales, dan cuenta de la relación entre BDNF y cognición, y de cómo influyen en ella elementos importantes como por ejemplo el género o el ejercicio. Sin embargo, se constata que aún la mayor parte de la investigación respecto a BDNF y síntomas cognitivos en psicosis se realiza en torno a la esquizofrenia como enfermedad. Por lo tanto, es necesario ampliar el estudio de la relación entre BDNF y síntomas cognitivos a cuadros psicóticos de distintos estadios y orígenes

Brain Derived Neurotrophic Factor (BDNF) has been linked to cognitive symptoms of schizophrenia, which has been documented in previous reviews. However, recently the focus of neurobiological research has moved from studying schizophrenia as a disease to studying psychosis as a group. The main aim of this research was to carry out an updated review of all relevant publications in the last 5 years (2013 to 2018) regarding BDNF and cognitive symptoms, both in schizophrenia and in psychosis. In order to achieve this, the keywords BDNF, cognitive and schizophrenia were reviewed in PubMed, and then this process was repeated with the word psychosis. As a result, in this article we describe the way in which different studies, both in human beings and in animal models, account for the relation between BDNF and cognition, and for the way in which important elements such as gender or exercise influence it. However, we found that still most of the research regarding BDNF and cognitive symptoms in psychosis is done around schizophrenia as a disease. Therefore, it is necessary to expand the study of the relationship between BDNF and cognitive symptoms to psychotic illnesses of different stages and origins

Correlates of Activities of Daily Living in Demented and Non-Demented Elderly

BACKGROUND: This study's aim is to compare the correlates of instrumental and physical activities of daily living (ADL) according to the presence or absence of dementia in an elder populated community. METHODS: This study was part of a community survey of late-life psychiatric morbidity carried out in Kwangju, South Korea in 2001. The Instrumental Activities of Daily Living Scale was administered to 740-community residents aged 65 or over. Data on the demographic characteristics (age, gender, living area, marital state, and religion), socio-economic state (education, monthly income, number of rooms, previous occupation, current employment, and social network), and clinical characteristics (cognitive function, physical illness, and depression) were gathered. RESULTS: The instrumental ADL impairment was associated significantly with higher age and lower cognitive functional ability in both groups. However, the impairment was shown in those without dementia, currently unemployed and had no spouse. The physical ADL impairment was significantly associated with lower cognitive function and higher number of physical illnesses in those with dementia, while it was significantly associated with higher age and severe depressive symptoms in those without dementia. The accountability portion of the above correlates for the variances of the instrumental and physical ADL was high in those with dementia, but was unacceptably low in those without dementia. CONCLUSIONS: It was suggested that the correlates and utility of ADL scale might vary according to dementia state.

Clinical Manifestation of Dementias

Symptoms of dementia vary widely according to the etiology, nature, progression of the causative disease. Not only various cognitive and non-cognitive features are present in any given point of evaluation, but also it is very common to note the ups and downs of such symptoms in an individual patient as the disease progress. Although cortical degenerative dementia such as Dementia of Alzheimer's Type typically show cognitive deficit in language, memory, praxis etc. in its early stage, it is unwise to confine such symptoms to be characteristic only in cortical dementias. Likewise, neurologic symptoms or changes in affect, personality and behavior, frequently seen in vascular dementia or other subcortical degenerative dementias should be understood as a part of whole cognitive and behavioral symptomatic gamut. As a logical conclusion, when evaluating the symptoms of a dementic patient, all the physical, neurologic, and neuropsychiatric evaluation must be applied as well as neuropsychological assessments. In addition, attention must be paid on the patients' functionality of daily living, reversibility, and appropriateness of services by family members or caregivers.