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This narrative review addresses the complex relationship between neurological diseases and artistic expression, which can have a profound impact on a painter´s works. This exploration highlights the dynamic and ever-evolving connection between neuroscience and art, offering insights into the extraordinary ways in which the human brain and artistic expression intersect and evolve. Following brain damage, there may be the emergence of sudden artistic talents, intriguing changes in the styles of established artists, the paradoxical facilitation of artistic abilities despite the cognitive decline consequent to these injuries, besides coping strategies that artists adopt in response to the challenges of health. Therefore, this article investigates different scenarios where brain injuries and disorders have had a profound impact on artists, leading to the emergence of new talents, changes in artistic styles, and unexpected improvements in their work, as well as adaptations in their artistic practices, as represented by some painters such as Tommy McHugh (1949 -2012), Francisco Goya (1746-1828), Otto Dix (1891-1969), Willem de Kooning (1904-1997), William Charles Utermohlen (1933-2007) and Charles Meryon (1821-1868). Consequently, works of art can be valuable but understudied tools for understanding brain dysfunction, although they must be interpreted with great care.
Esta revisão narrativa aborda a complexa relação entre doenças neurológicas e expressão artística, que pode ter um impacto profundo na obra de um pintor. Esta exploração destaca a conexão dinâmica e em constante evolução entre a neurociência e a arte, oferecendo insights sobre as formas extraordinárias pelas quais o cérebro humano e a expressão artística se cruzam e evoluem. Após danos cerebrais, pode haver o surgimento de talentos artísticos repentinos, mudanças intrigantes nos estilos de artistas estabelecidos, a facilitação paradoxal de habilidades artísticas, apesar do declínio cognitivo consequente a essas lesões, além de estratégias de enfrentamento que os artistas adotam em resposta aos desafios de saúde. Portanto, este artigo investiga diferentes cenários onde lesões e distúrbios cerebrais tiveram um impacto profundo nos artistas, levando ao surgimento de novos talentos, mudanças nos estilos artísticos e melhorias inesperadas em seu trabalho, bem como adaptações em suas práticas artísticas, bem como representado por alguns pintores como Tommy McHugh (1949 -2012), Francisco Goya (1746-1828), Otto Dix (1891-1969), Willem de Kooning (1904-1997), William Charles Utermohlen (1933-2007) e Charles Meryon (1821-1868). Consequentemente, as obras de arte podem ser ferramentas valiosas, mas pouco estudadas, para a compreensão da disfunção cerebral, embora devam ser interpretadas com muito cuidado.
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Introduction: Obesity is on rise globally and may have a impact on cognition. Very limited research was done on the association of weight with neurocognition among the elderly. The study purpose was to determine the correlation between BMI and age with MCI and after stratifying for BMI and socio-demographic characteristics.Methods: This cross-sectional study was conducted among 576 elderly (≥60 years) in Guwahati city using a multi-stage sampling technique. Hindi Mini-Mental State Examination (HMMSE) tool was used for screening for dementia and MCI. Results: HMMSE scores were not significantly correlated with BMI (r =0.07). However, when strati-fied, a significantly negative correlation of BMI with HMMSE scores was seen for illiterates (r =-0.21), primary school education (r =-0.48) and unskilled workers (r =-0.49). There was a significant negative correlation between age and cognition for elderly belonging to OBC, (r =-0.21), Lower middle (III), (r =-0.39), Upper Lower (r =-0.17), Lower (V), (r =-0.26), Graduate, Post Graduate,(r = -0.23), Middle School, (r =-0.36), Illiterate, (r =-0.34), Clerical, (r =-0.60), Semi Professional, (r =-0.62), skilled worker (r=-0.68), Unemployed, (r =-0.15) and Obese, (r =-0.30). Conclusion: Various factors like age, category, socioeconomic status, and Body Mass Index (BMI) were found to be predictors of cognition among the elderly.
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Background: Malnutrition is a common condition among elderly people with dementia and is associated with low nutrient and calorie intake. There are no data about efficacy of intervention with nutritional supplements in addition to medication in cognitive decline people. Aims and Objectives: we aimed to find out the nutritional status of patients with cognitive decline and to ascertain the effects of nutritional supplements with medication in such patients. Materials and Methods: This observational study was conducted for 12 months. All patients admitted with cognitive decline as per the mini-mental state examination score were included after informed consent. The demographic details, clinical features, treatment given, and response to treatment were noted and tabulated as mean ± and SD and analyzed statistically. Results: Maximum patients were found to be of moderate degree cognitive decline and were at risk of malnutrition. There was significant improvement in cognitive status and behavioral symptoms after 12 months of treatment with nutritional supplements and drugs in our study population. Conclusions: Addition of nutritional supplements to drug therapy does provides significant advantages in cognition and neuropsychiatric symptoms. They did add a lot in rectifying the deficiency of different nutritional parameters and thereby improving the domains such as nutritional functions and activity of daily living.
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Background: Atypical presentations of acute coronary syndrome (ACS) delay its recognition and treatment in the elderly patients. Functional decline and delirium which are common to the elderly during hospitalization, leads to cognitive impairment and poor health outcomes. Steps taken for its prevention is usually not considered the top priority by the cardiologist. The present study was conducted to identify cognitive decline among elderly patients who developed ACS during hospitalization for noncardiac illness and their outcome. Materials and Methods: Three hundred and ten elderly patients above 60 years of age with ACS were included from June 26, 2020 to October 13, 2020. Subjects were divided into those admitted primarily due to an ACS (Group I, n = 94) and those developing ACS following admission for noncardiac illness (Group II, n = 216). Co-morbidities, medications, investigations, management, clinical outcome, and Montreal Cognitive Assessment scale were compared between the two groups at the time of admission, after 30 days and after 6 months. Results: Majority of the subjects were admitted due to acute kidney injury (27.1%) in Group II and had a non-ST elevation ACS (90.2%). Optimum management was given to a lesser extent due to the clinical condition of these patients. Poor clinical outcome, cognitive impairment during hospitalization and cognitive decline during follow-up was more in Group II. Conclusion: Clinicians must be vigilant for the development of cognitive impairment and cognitive decline when an elderly patient is admitted to the hospital, as early detection and optimum management provides better clinical and cognitive outcome.
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China is facing the peak of an ageing population, and there is an increase in demand for intelligent healthcare services for the elderly. The metaverse, as a new internet social communication space, has shown infinite potential for application. This paper focuses on the application of the metaverse in medicine in the intervention of cognitive decline in the elderly population. The problems in assessment and intervention of cognitive decline in the elderly group were analyzed. The basic data required to construct the metaverse in medicine was introduced. Moreover, it is demonstrated that the elderly users can conduct self-monitoring, experience immersive self-healing and health-care through the metaverse in medicine technology. Furthermore, we proposed that it is feasible that the metaverse in medicine has obvious advantages in prediction and diagnosis, prevention and rehabilitation, as well as assisting patients with cognitive decline. Risks for its application were pointed out as well. The metaverse in medicine technology solves the problem of non-face-to-face social communication for elderly users, which may help to reconstruct the social medical system and service mode for the elderly population.
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Aged , Humans , Cognitive Dysfunction/prevention & control , Aging , China , Internet , TechnologyABSTRACT
Background Occupational aluminum exposure may associate with cognitive impairment in workers. At present, brain functional imaging data are not available for evaluating cognitive dysfunction in workers with occupational exposure to aluminum. The role of brain functional connectivity in cognitive decline associated with occupational aluminum exposure is not clear yet. Objective To explore potential mediating effect of brain functional connectivity value on cognitive decline induced by occupational aluminum exposure, to assess the relationship between cognitive impairment and brain functional connectivity, and to identify appropriate imaging evidence of early cognitive changes induced by occupational aluminum exposure. Methods This study used a subset data from a previous cross-sectional survey. Based on the data of aluminum-exposed workers, over 40 years old, aluminum-exposed working years >1 year, Montreal International Cognitive Assessment (MoCA) (Beijing version) score <26 points, 20 workers were selected as the case group, and 40 healthy workers with the same basic conditions (age, smoking, drinking, etc.) in non-aluminum production were selected as the control group with a 1∶2 matching ratio. The basic information of the subjects was collected, plasma aluminum level and cognitive function level were evaluated, and different brain functional connectivity values of default mode network (DMN) were measured by magnetic resonance imaging. The mediating effect analysis was conducted to examine the role of brain functional connectivity in the relationship between aluminum exposure and cognitive function. Results The plasma aluminum concentration of the case group was 1.76 times higher than that of the control group [(33.04±12.02) µg·L−1 vs (18.74±8.95) µg·L−1, P<0.05]; the MoCA score was 9.5 points lower [(18.35±2.64) vs (27.85±0.92), P<0.05]. The mean functional connection values of DMN1 and DMN2 in the case group were lower than those in the control group (P<0.05). The mean functional connection values of the left precuneus, left middle cingulate cortex, left superior medial gyrus, left precentral gyrus, and left cerebellum also decreased in the case group compared with the control group (P<0.05). Plasma aluminum concentration was negatively correlated with DMN1 functional connectivity value and MoCA scores (b=−0.004, 95%CI: −0.008–−0.001; b=−0.15, 95%CI: −0.233–−0.067; P<0.05). The mean functional connection values of DMN1 and DMN2 were positively correlated with MoCA scores (b=10.945, 95%CI: 5.574–16.316; b=10.107, 95%CI: 2.457–17.758; P<0.05). With the increase of plasma aluminum concentration, MoCA score decreased, but when the plasma aluminum concentration exceeded 19.50 µg·L−1, MoCA score decreased slowly. With the increase of the mean functional connectivity value of DMN1, MoCA score increased, but when the mean functional connectivity value of DMN1 exceeded 1.05 and continued to increase, the increase of MoCA score slowed down. The results of mediating effect analysis showed that the functional connectivity value of DMN1 partially mediated the relationship between plasma aluminum concentration and MoCA score, and the mediating effect was 25.80%. Conclusion Cognitive impairment in occupational aluminum-exposed workers is closely related to brain resting-state functional connectivity. There is a dose-response relationship of plasma aluminum concentration with DMN1 functional connectivity value and MoCA scores, and DMN1 functional connectivity value partially mediates the relationship between plasma aluminum concentration and MoCA scores. The brain functional connectivity value can be used as meaningful imaging data to study the cognitive decline induced by chronic aluminum exposure.
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En los últimos años, ha existido un interés creciente por entender la naturaleza del lenguaje en el envejecimiento normal. Existen diversas investigaciones y teorías que exponen los cambios que se producen en los diferentes niveles del lenguaje, a saber, nivel morfosintáctico, fonológico, léxico, discursivo. Estos cambios estarían relacionados con el declive de la memoria operativa y la velocidad de procesamiento. La necesidad de realizar una revisión bibliográfica teórica sobre esta temática se sustenta en dos razones esenciales, la primera es la trascendencia de la comunicación y del lenguaje para el individuo; la segunda se centra en cambiar la mirada de la declinación de la capacidad comunicativa a buscar las posibilidades y alternativas para conservarla. El objetivo de este trabajo fue describir los cambios asociados con la edad en el lenguaje y buscar estrategias para preservar el mismo. Se proponen diversas actividades que estimulen la neuroplasticidad neuronal y aumenten la reserva cognitiva en los adultos mayores. Las mismas tienen como objetivo trabajar sobre los déficits descritos anteriormente y que han sido propuestos como responsables del declive de los distintos niveles del lenguaje.
In recent years, there has been a growing in understanding the nature of language in normal aging. There are varios investigations and theories that expose the changes that occur at different levels of language: morphosyntactic, phonological, lexical, discursive level. These changes would be related to the decline of working memory and processing speed. The need to carry out a theoretical bibliographic review on this subject is based on two essential reasons, the first is the importance of communication and language for the human; the second focuses on changing the perspective of the fall of communicative capacity to search for possibilities and alternatives to preserve it. The objective of this work was to describe the changes associated with age in language and to search strategies to preserve it. Various activities are proposed to stimulate neuronal neuroplasticity and increase cognitive reserve in older adults. They aim to work on the déficits described aove and that have been proposed as responsable for the decline of the different levels of language.
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HumansABSTRACT
ObjectiveTo investigate the relationship between e-cigarette use and subjective cognitive decline. MethodsThis study included survey participants aged ≥45 years from the US Behavioral Risk Factor Surveillance System. The prevalence of subjective cognitive decline in people with different tobacco use conditions was estimated. Multivariate logistic regression was employed to determine the relationship between e-cigarette use and subjective cognitive decline， as well as the relationship between co-use of e-cigarette and combustible tobacco and subjective cognitive decline. ResultsA total of 204 032 participants were included in the study. The total prevalence of subjective cognitive decline was 11.46%， whereas among current e-cigarette users， the prevalence was 19.92%. After accounting for confounding factors， current e-cigarette use was identified as a risk factor for subjective cognitive decline compared to individuals who had never used e-cigarettes， with an OR of 1.46 （95%CI： 1.20‒1.77）. Meanwhile， occasional e-cigarette use showed a higher risk， with an OR of 1.54 （95%CI： 1.22‒1.95）. The highest risk was observed with the co-use of e-cigarette and combustible tobacco， with an OR of 1.69 （95%CI： 1.32‒2.16）， followed by current e-cigarette use and former combustible tobacco use， with an OR value of 1.38 （95%CI： 1.08‒1.78）. ConclusionThe use of e-cigarettes increases the risk of subjective cognitive decline， with occasional use demonstrating a more pronounced negative impact. In general， the risk of cognitive decline is greater among e-cigarette users compared to combustible tobacco users. Controlling the use of combustible tobacco， especially e-cigarette， will help reduce the incidence of subjective cognitive decline. Individuals currently using combustible tobacco are advised to explore smoking cessation methods other than transitioning to e-cigarettes.
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Objective:To observe any effect of virtual reality (VR) training on the cognitive functioning and functional fitness of nursing home residents with subjective cognitive decline (SCD).Methods:Fifty-six of such residents were randomly divided into an observation group and a control group, each of 28. Both groups received health education and routine care, but the observation group was additionally provided with 45 minutes of VR training three times a week for 6 months. The training included Baduanjin, magic, flying bird, supermarket shopping, gravity ball and gym episodes. Both groups′ cognition was evaluated using the subjective cognitive decline questionnaire (SCD-Q), the Montreal cognitive assessment (MoCA), the Rivermead Behavioural Memory Test (second edition) (RBMT-Ⅱ), a digit symbol substitution test (DSST), an animal fluency test (AFT) and trail-making test A-B (TMT A-B). Functional fitness was quantified using the 8-foot up-and-go test (8UGT), a 30-second arm curl test (30sACT), a 30-second chair stand test (30sCST), a back scratching test (BST), the sit-and-reach test (CSRT) and a 2-minute step test (2MST) before and after the 6-month intervention.Results:After the intervention, the average SCD-Q, MoCA, RBMT-Ⅱ, DSST, TMT-A, and TMT-B scores of the observation group were significantly better than before the intervention, and significantly better than the control group′s averages. And except for the back scratching their functional results were also significantly better, on average, than those of the control group.Conclusions:VR training can effectively improve the cognition and functional fitness of nur-sing home residents with SCD. Such training is worthy of promotion and wider application in nursing homes.
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Objective:To analyze the correlation between ambulatory blood pressure variability and the progression of subjective cognitive decline (SCD).Methods:In this prospective observational study, the overall sampling method was used to continuously select 100 patients with SCD in the Department of Neurology, Changshu First People′s Hospital and Changshu Xinzhuang People′s Hospital from January 1 2016 to June 30 2017. The baseline demographic characteristics of the patients were collected. The Chinese version of SCD-Q9 questionnaire was used to self-evaluate SCD, and the Montreal Cognitive Assessment Scale (MoCA) was used to evaluate objective cognitive impairment. All patients received 24 h ambulatory blood pressure monitoring, and 24 h systolic coefficient of variation (SCV) and diastolic coefficient of variation (DCV) were calculated. The follow-up period was 4 years after the first visit, and the MoCA scale was evaluated once a year. Finally, 83 patients completed the follow-up and were included in this study. According to the MoCA score at the end of follow-up (<26 or ≥26), the patients were divided into progression group (39 cases) and non-progression group (44 cases). The difference of MoCA score between baseline and last follow-up was calculated in the progression group. The difference in demographic characteristics between the two groups was compared with χ2 test. The difference of 24 h SCV and 24 h DCV between the two groups were compared by rank sum test. The correlation between 24 h SCV and MoCA score difference or SCD-Q9 score in the progression group were tested by multiple linear regression analysis. Results:The 4-year progression rate of SCD patients was 46.99% (39/83). There was no significant differences in baseline age, gender, education level, medical history, smoking history, SCD-Q9 score and MoCA score between the progressive group and the non-progressive group (all P>0.05). The 24 h SCV in the progressive group was significantly higher than that in the non-progressive group [13.4% (9.9%, 15.6%) vs 10.9% (9.7%, 12.7%), U=594.50, P=0.016]. There was no significant difference in 24 h DCV between the two groups ( P>0.05). In progressive group, the 24 h SCV was negatively correlated with MoCA score difference ( r=-0.368, P=0.021). Conclusion:There is a correlation between ambulatory blood pressure variability and SCD progression, high 24 h SCV may be one of the factors of SCD progression and has certain predictive value.
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Atrial fibrillation (AF) confers a 2-to-3-fold increased risk of developing cognitive dysfunction and dementia, independent of age and past stroke. The purpose of study was to identify risk factors for developing dementia amongst AF patients in India. This was a single-centre, prospective, observational study wherein recently diagnosed, treatment naïve, persistent non-valvular AF patients were enrolled. All patients were screened for dementia using the Mini-Mental state exam. Amongst a total of 108 patients enrolled, 40 (37%) had dementia. The most common cognitive deficits were in attention and calculation followed by memory deficits. Factors independently contributing to dementia were advanced age, female sex, presence of diabetes, elevated pulmonary artery pressures and a lower serum albumin.
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Background:Parkinson disease(PD)is one of the most common age-related brain disorders, with cardinal symptoms rigidity, bradykinesia, resting tremor and postural instability. These aredopamine-related motor symptoms.PD is increasingly recognized as heterogeneous multisystem disorder involving other neurotransmitter associated with nonmotor symptoms. In whichcognitive decline is the most common and important NMS. cognitive decline in PD makes profound effect on patient quality of life and imposes significant burden on the caregiver.Methods:Hospital based cross sectional study conducted among 52 patients of idiopathic Parkinson disease, 61 to 80 years of age (fulfilling UKPDS brain bank criteria) at GSVM medical college, Kanpur during February 2020 to October2021 using SCOPA COG scale.Results:Using SCOPA COG score in 52 patients,17 (33%) patients foundwith declined cognition There was weak negative correlation betweentotal score and duration of illness(p=0.091), weak negative correlation between executive function (assessed by dice) and duration of illness (p=0.047)and a moderate negative correlationbetween visuospatial function (assessed by assembling pattern) and duration of illness (p=0.003).Conclusions:Significant cognitive decline found with increase in duration of illness in terms of visuospatial function.
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Abstract Introduction: Polypharmacy and cognitive decline are both common problems in the elderly. Objective: To determine the relationship between polypharmacy and cognitive status among elderly with cardiovascular disease. In this cohort study, 120 older people with polypharmacy and the same number non-polypharmacy were selected from Clinics in Sari Heart Center, Iran, according to inclusion criteria between October 2019 and January 2020. Materials and method: Data collection tools included Cognitive State Test (COST) and Geriatric Oral Health Assessment Index, Geriatric Depression Scale, Anatomic Therapeutic Chemical drug questionnaire, and a medical-demographic questionnaire. Data were analyzed using the χ2 test, independent t-test, logistic, and linear regression test. Results: Mean age of poly-pharmacy and non-poly pharmacy groups was 67.63 ± 6.67 and 66.09 ± 6.21 21 years, respectively (p = 0.065). Women ratio was significantly more among the poly-pharmacy group, compared to non-polypharmacy (p = 0.007). The odds ratio of cognitive decline increased by 3.17 times with poly-pharmacy (95% confeind intervel: 2.48-4.05). The most predictors of cognition were polypharmacy, income, hypertension, and gender, respectively. The predictive power of the model was 48.9%. Conclusion: Regarding the significant relationship between poly-pharmacy and cognitive status, it should be considered as one of the approaches to increase the cognitive status among older adults. Furthermore, it is necessary to emphasize on the factors affecting cognitive status among older people in programs, to improve the medical and health services for them.
Resumen Introducción: Tanto la polifarmacia como el deterioro cognitivo son problemas comunes entre los adultos mayores. Objetivo: Establecer la relación entre la polifarmacia y el estado cognitivo de los adultos mayores con enfermedad cardiovascular. En este estudio de cohorte se seleccionaron 120 adultos mayores con polifarmacia e igual número sin polifarmacia de las clínicas en Sari Heart Center, Irán, de acuerdo con los criterios de inclusión, entre octubre del 2019 y enero del 2020. Materiales y método: Las herramientas de recolección de datos incluyeron el Cognitive State Test (COST) y Geriatric Oral Health Assessment Index (GOHAI), el Geriatric Depression Scale, el cuestionario de medicamentos Anatomic Therapeutic Chemical (ATC), y un cuestionario médico-demográfico. Los datos se analizaron con la prueba de Chi-cuadrado, la prueba t para muestras independientes, y pruebas de regresión logística y lineal. Resultados: La edad media de los grupos con y sin polifarmacia fue de 67,63± 6,67 y 66,09 ± 6,21 años, respectivamente (p = 0.065). La proporción de mujeres fue significativamente más alta en el grupo con polifarmacia comparada con el grupo sin polifarmacia (p = 0.007). La razón de disparidad del deterioro cognitivo aumentó 3,17 veces con la polifarmacia (IC 95%: 2,48 y 4,05). Los mayores predictores de cognición fueron la polifarmacia, los ingresos, la hipertensión y el género, respectivamente. El poder predictivo del modelo fue de 48,9%. Conclusión: Respecto a la relación significativa entre la polifarmacia y el estado cognitivo, se debe considerar como uno de los abordajes para aumentar el estado cognitivo en los adultos mayores. También es necesario enfatizar en los factores que afectan el estado cognitivo de los adultos mayores participantes en los programas, para mejorar los servicios médicos y de salud dirigidos a ellos.
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As a preclinical stage of Alzheimer′s disease, subjective cognitive decline has attracted extensive attention of researchers at home and abroad in recent years. At this stage, targeted intervention according to the influencing factors of subjective cognitive decline is an effective entry point to delay the occurrence of dementia. This paper summarized the evaluation method, influencing factors and preventive measures of subjective cognitive decline, in order to provide a theoretical basis for the prevention and treatment of cognitive decline in the elderly.
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Objective:To develop a Beijing norm of Memory and Executive Screening (MES) scale to facilitate its further promotion and application in the future.Methods:Study subjects were selected based on the inclusion and exclusion criteria, including patients who visited the memory clinic of Xuanwu Hospital of Capital Medical University from March 20, 2017 to January 6, 2021, and normal people recruited simultaneously from community, and trained and qualified investigators conducted questionnaire surveys through face-to-face interviews. Then strict quality control, data collection and statistical analysis were performed.Results:A total of 607 participants were included, including 239 normal people, 293 individuals with subjective cognitive decline (SCD), and 75 individuals with mild cognitive impairment (MCI). There was a negative correlation between the scores of MES and age ( r=-0.19, P<0.001), but a positive correlation between scores of MES and education level ( r=0.29, P<0.001). The optimal cut-off value of this scale in Beijing was 86 points, the area under curve (AUC) of the cut-off value to distinguish MCI was 0.847 (normal people vs MCI) and 0.826 (SCD vs MCI), and after adding demographic variables, AUC showed slight increase (0.847 to 0.850 and 0.826 to 0.847), whereas the differences were not statistically significant ( Znormal peoplevsMCI=0.49, ZSCDvsMCI=1.21, P>0.05). And there was no statistically significant difference between MES and Montreal Cognitive Assessment scales in diagnostic power for normal people and people with MCI ( Zscale alone=1.03, Zafter adding demographic variables=1.13, P>0.05). Conclusions:The MES scale has a better distinguishing power for MCI, and its optimal cut-off value in Beijing is 86 points, which is different from previous studies. In the future, the sample size needs to be further expanded to verify this norm.
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Objective:To investigate the characteristics and clinical related factors of Parkinson′s disease (PD) patients with subjective cognitive decline (SCD).Methods:Ninety-nine PD patients with normal cognitive function enrolled in Beijing Hospital from January to December 2018 were collected for the study. Patients with PD were divided into groups with ( n=57) and without ( n=42) SCD using the first question in Part 1 of the Unified Parkinson′s Disease Rating Scale (UPDRS). All patients were assessed by Montreal Cognitive Assessment (MoCA), modified Hoehn-Yahr grading, UPDRS, Hamilton Rating Scale for Depression (HAMD), Hamilton Rating Scale for Anxiety (HAMA), Parkinson′s Disease Sleep Scale, Ability of Daily Living Scale and 39-item Parkinson′s Disease Questionnaire (PDQ-39). Levodopa equivalent dose conversion was performed for patients taking anti-PD drugs. Patients′ self-reported years of formal education were collected. Results:The proportion of PD with SCD in this group was 57.58% (57/99). There were statistically significant differences in MoCA [28.00 (27.00, 29.00) vs 28.00 (27.00, 29.00) ,Z=-2.28, P=0.023], HAMD [6.00 (5.00, 8.50) vs 5.00 (2.00, 8.00), Z=-2.23, P=0.026], HAMA [7.00 (6.00, 11.00) vs 6.00 (3.00, 8.25) , Z=-2.70, P=0.007], PDQ-39-emotional health [2.00 (0, 5.00) vs 1.00 (0, 3.00), Z=-2.03, P=0.042] and PDQ-39-cognitive scores [4.00 (2.00, 5.00) vs 2.00 (0, 4.00), Z=-3.42, P=0.001] between PD with and without SCD groups. SCD was correlated with MoCA ( r=-0.23, P=0.022), HAMD ( r=0.23, P=0.025) and HAMA ( r=0.27, P=0.006) scores to varying degrees. When controlling for HAMD and HAMA scores, the correlation between SCD and MoCA scores ( r′=-0.18, P=0.084) was no longer existed. Conclusions:SCD is common in PD patients with normal cognitive function and is associated with poorer cognitive performance and more severe symptoms of depression and anxiety. In this group of patients, the relationship between SCD and affective symptoms may be greater than that of objective overall cognitive function, which is worthy of further studies.
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ABSTRACT Cognitive decline can be screened by the clock drawing test (CDT), which has several versions. Objective: This survey aimed to analyze the correlation between two simple methods for scoring the CDT. Methods: This cross-sectional study was nested in the Elo-Creati cohort from Passo Fundo, Brazil and comprised 404 subjects. Two raters underwent previous training and scored the subjects' CDT according to both the Pfizer and Shulman systems. The inter-observer and intra-observer concordance within each method was analyzed with the Spearman's rank correlation coefficient, as well as the concordance of the scores between the two methods. Age and scholarity were also correlated with the scores. Results: Most of the participants were women (93.8%) and Caucasian (84.6%), with a mean age of 66.9 (±7.8) years and a scholarity of 10.9 years (±5.6). There was significant inter-observer (Pfizer: r=0.739, p£0.001; Shulman: r=0.727, p£0.001) and intra-observer correlation (Pfizer: rater 1, r=0.628, p≤0.001; rater 2, r=0.821, p≤0.001; Shulman: rater 1, r=0.843, p≤0.001; rater 2: r=0.819; p≤0.001). Intra-observer correlation was also observed comparing Pfizer and Shulman methods (rater 1: r=0.744; p≤0.001; rater 2: r=0.702; p≤0.001). There was weak correlation of the scores with scholarity (Pfizer: r=0.283, p£0.001; Shulman: r=0.244, p£0.001) and age (Pfizer: r=-0.174, p£0.001; Shulman: r=-0.170, p£0.001). More participants were classified with decreased cognition through the Pfizer system (rater 1: 44.3 vs. 26.5%; rater 2: 42.1 vs. 16.3%; p≤0.001). Conclusions: For this population, our results suggest that the Pfizer system of scoring CDT is more suitable for screening cognitive decline.
RESUMO O déficit cognitivo pode ser triado pelo teste do desenho do relógio (TDR), que tem várias versões. Objetivo: Esta pesquisa visou avaliar a concordância entre dois métodos simples de TDR. Métodos: Estudo transversal, aninhado na coorte Elo-Creati de Passo Fundo, Brasil, que incluiu 404 sujeitos. Dois avaliadores previamente treinados analisaram o TDR dos participantes de acordo com os sistemas de Pfizer e de Shulman. A concordância inter e intraobservador foi analisada com o teste de coeficiente de correlação de postos de Spearman, assim como a concordância pela estatística kappa dos escores entre os métodos. Idade e escolaridade também foram correlacionados com os escores. Resultados: A maioria dos participantes era de mulheres (93,8%) e caucasianos (84,6%), com média de idade de 66,9±7,8 anos e de escolaridade de 10,9±5,6 anos. Houve significativa correlação interobservador (Pfizer: r=0,739, p£0,001; Shulman: r=0,727, p£0,001) e intraobservador (Pfizer: avaliador 1, r=0,628, p≤0,001; avaliador 2, r=0,821, p≤0,001; Shulman: avaliador 1, r=0,843, p≤0,001; avaliador 2: r=0,819; p≤0,001). Correlação intraobservador significativa também foi evidenciada comparando-se os sistemas de Pfizer e Shulman (avaliador 1: r=0,744; p≤0,001; avaliador 2: r=0,702; p≤0,001). Houve fraca correlação dos escores com escolaridade (Pfizer: r=0,283, p£0,001; Shulman: r=0,244, p£0,001) e idade (Pfizer: r=-0,174, p£0,001; Shulman: r=-0,170, p£0,001). Mais participantes foram classificados com declínio cognitivo com o sistema de Pfizer (avaliador 1: 44,3 vs. 26,5%; avaliador 2: 42,1 vs. 16,3%; p≤0,001). Conclusões: Nossos resultados sugerem que, para essa população, o sistema de Pfizer para avaliar o TDR é mais adequado para a triagem cognitiva.
Subject(s)
Humans , Female , Middle Aged , AgedABSTRACT
ABSTRACT. The preclinical stages of dementia include subtle neurocognitive changes that are not easily detected in standard clinical evaluations. Neuropsychological evaluation is important for the classification and prediction of deterioration in all the phases of dementia. Objective: Compare the neuropsychological performance in healthy older adults with subjective cognitive decline (SCD) and with mild cognitive impairment (MCI) using principal components analysis. Methods: We evaluated 94 older adults with a clinical protocol which included general measures of mental, emotional and functional state. The neuropsychological protocol included tasks of memory, executive function, attention, verbal fluency and visuoconstructional abilities. We used principal component analysis (PCA) to reduce variables´ dimensionality on neuropsychological evaluation. Results: 33(35%) participants had a normal cognitive function, 35(37%) had subjective cognitive decline and 26(28%) had a mild cognitive impairment. The PCA showed seven factors: processing speed, memory, visuoconstruction, verbal fluency and executive components of cognitive flexibility, inhibitory control and working memory. ANOVA had shown significant differences between the groups in the memory (F=4.383, p=0.016, η2p=0.087) and visuoconstructional components (F=5.395, p=0.006, η2p=0.105). Post hoc analysis revealed lower memory scores in MCI than SCD participants and in visuospatial abilities between MCI and SCD and MCI and Normal participants. Conclusions: We observed differentiated cognitive profiles among the participants in memory and visuoconstruction components. The use of PCA in the neuropsychological evaluation could help to make a differentiation of cognitive abilities in preclinical stages of dementia.
RESUMO. Os estágios pré-clínicos da demência incluem mudanças neurocognitivas sutis que não são facilmente detectadas nas avaliações clínicas padrão. A avaliação neuropsicológica é importante para a classificação e predição da deterioração em todas as fases da demência. Objetivo: Comparar o desempenho neuropsicológico em idosos saudáveis com declínio cognitivo subjetivo (DCS) e com comprometimento cognitivo leve (CCL) por meio da análise de componentes principais. Métodos: Avaliaram-se 94 idosos com um protocolo clínico que incluía medidas gerais do estado mental, emocional e funcional. O protocolo neuropsicológico incluiu tarefas de memória, função executiva, atenção, fluência verbal e habilidades visuoconstrutivas. Utilizou-se a análise de componentes principais (PCA, na sigla em inglês) para reduzir a dimensionalidade das variáveis na avaliação neuropsicológica. Resultados: Um total de 33 (35%) participantes apresentavam função cognitiva normal, 35 (37%) declínio cognitivo subjetivo e 26 (28%) comprometimento cognitivo leve. A PCA apresentou sete fatores: velocidade de processamento, memória, visuoconstrução, fluência verbal e componentes executivos de flexibilidade cognitiva, controle inibitório e memória de trabalho. ANOVA mostrou diferenças significativas entre os grupos na memória (F=4,383, p=0,016, η2p=0,087) e componentes visuoconstrutivos (F=5,395, p=0,006, η2p=0,105). A análise post hoc revelou escores de memória mais baixos no CCL do que os participantes com DCS e nas habilidades visuoespaciais entre CCL e DCS e CCL e participantes normais. Conclusões: Observaram-se perfis cognitivos diferenciados entre os participantes nos componentes de memória e visuoconstrução. O uso da PCA na avaliação neuropsicológica poderia auxiliar na diferenciação das habilidades cognitivas em estágios pré-clínicos da demência.
Subject(s)
Cognitive Dysfunction , NeuropsychologyABSTRACT
Abstract The objective of this research is to describe the relationship between depressive disorder and cognitive deterioration in residentialized elderly people. This is a descriptive and correlational study with 70 elderly. The variables have been assessed with a Psychosocial Variables Questionnaire, CAMCOG and GDS. Depression was significantly correlated with cognitive level in the non-assisted elderly sample (r=0.471, p=0.004). Participants' age is negatively associated with the score obtained in the CAMCOG of non-assisted sample (r=-0.352, p=0.038). Depression is more frequent in institutions that care for older people when they are more dependent.
Resumo O objetivo deste trabalho é determinar a relação entre transtorno depressivo e comprometimento cognitivo na população idosa institucionalizada. Foi realizado um estudo descritivo e correlacional com 70 idosos espanhóis. Para a medição das variáveis, foi utilizado um Questionário de Variáveis Psicossociais, o CAMCOG do CAMDEX e GDS. A depressão se correlaciona significativamente com o nível cognitivo na maioria dos adultos não dependentes (r=−0,471; p=0.004). A idade está significativamente associada e inversamente para a pontuação obtido no CAMCOG na faixa dependente (r=−0,352; p=−0,038). A depressão está ligada às instituições que atendem prefeitos quando são muito dependentes.
Resumen El objetivo del presente trabajo es determinar la relación entre el trastorno depresivo y el deterioro cognitivo en una población mayor institucionalizada. Se ha realizado un estudio descriptivo y correlacional con 70 mayores españoles. Para la medida de las variables se ha usado un Cuestionario de Variables Psicosociales propio, el CAMCOG del CAMDEX y la GDS. La depresión se correlaciona significativamente con el nivel cognitivo en la muestra de mayores no dependientes (r=−0.471; p=0.004). La edad se asocia elocuentemente y de forma inversa con la puntuación obtenida en el CAMCOG en la muestra de dependientes (r=−0.352; p=−0.038). La depresión está vinculada a las instituciones que atienden a mayores cuando éstos son más dependientes.
ABSTRACT
BACKGROUND@#The July 2018 Japan Floods caused enormous damage to western Japan. Such disasters can especially impact elderly persons. Research has shown that natural disasters exacerbated a decline in cognitive function, but to date, there have been no studies examining the effects of this disaster on the elderly. The object of this study was to reveal the effect of this disaster in terms of cognitive decline among the elderly.@*METHODS@#Study participants were certified users of the long-term care insurance (LTCI) system in Hiroshima, Okayama, and Ehime prefectures from May 2018 to June 2018. The observation period was from July 2018 to December 2018. Our primary outcome was cognitive decline after the disaster using a dementia symptomatology assessment. In addition to a crude model, a multivariate Cox proportional hazards model was used to assess the cognitive decline of victims, adjusting for age classification, gender, the level of dementia scale before the disaster occurred, residential environment, whether a participant used facilities shut down after the disaster, and population density. After we confirmed that the interaction term between victims and residential environment was statistically significant, we stratified them for the analysis.@*RESULTS@#The total number of participants was 264,614. Victims accounted for 1.10% of the total participants (n = 2,908). For the Cox proportional hazards model, the hazard ratio of the victims was 1.18 (95% confidential interval (CI): 1.05-1.32) in the crude model and 1.12 (95% CI: 1.00-1.26) in the adjusted model. After being stratified by residential environment, the hazard ratio of home victims was 1.20 (95% CI: 1.06-1.36) and the hazard ratio of facility victims was 0.89 (95% CI: 0.67-1.17).@*CONCLUSIONS@#This study showed that elderly living at home during the 2018 Japan Floods were at risk for cognitive decline. Medical providers, care providers, and local governments should establish a system to check on the cognitive function of elderly victims and provide necessary care support.