Mal de desembarque / Mal de debarquement

Resumen El síndrome de mal de desembarque es un cuadro clínico de mareo y oscilaciones corporales persistente, descrito siglos atrás cuando los marineros llegaban a tierra después de navegar. Actualmente, se sabe que este cuadro clínico ocurre también al bajarse de cualquier medio de transporte, ya sea marítimo, aéreo o terrestre. Cuando el cuadro clínico tiene una duración de tres o más días, se denomina mal de desembarque persistente, y se asocia a cefalea y mayores niveles de ansiedad y síntomas depresivos. A continuación, presentamos el cuadro clínico de un paciente que consultó por mareo persistente posterior a un paseo en bote en el mar. Se discute diagnóstico y manejo terapéutico.

Abstract Mal de Debarquement is a clinical syndrome characterized by persistent self-motion dizziness and increased oscillatory body sway, that was described centuries ago after sailors landed in port. Nowadays, it is known that mal de debarquement could appear after any travel in a motion vehicle, including airplanes, ships and cars. When the duration of the symptoms lasts longer than three days, a persistent mal de debarquement is diagnosed, and it is associated with headache and higher levels of anxiety and depressive symptoms. Here, we present a clinical case of a persistent mal de debarquement that attended to the Otolaryngology clinics at the Clinical Hospital of the University of Chile after a boat trip in the sea. We discuss diagnosis and clinical management.

Consecuencias de la hipertensión arterial en las funciones cognitivas / Consequences of Arterial Hypertension over Cognitive Functions

Introducción: La hipertensión arterial, por su influencia y afectación multisistémica, surge como un factor de riesgo potencial para el deterioro progresivo de las funciones cognitivas. Objetivo: Identificar las principales alteraciones cognitivas asociadas a la hipertensión arterial, específicamente en la atención y la memoria. Métodos: Se realizó revisión bibliográfica retrospectiva de 34 estudios, teniendo en cuenta los criterios de inclusión. Se estableció una ventana temporal en el período 2002 al 2019, incluyendo las bases de datos Pubmed, Scopus, Medline y SciELO. Los textos completos se sometieron a una lectura crítica y análisis documental mediante una matriz de rastreo. Conclusiones: Una de las consecuencias más importantes de esta enfermedad es la afectación en las funciones cognitivas particularmente la atención y la memoria, con una incidencia en el deterioro cognitivo leve, profundo y medio. Sin embargo, su impacto en la cognición es un área que recientemente ha despertado el interés en la neuropsicología y la neurociencia cognitiva. La hipertensión arterial está considerada como una de las enfermedades cardiovasculares que está vinculada con la demencia, proporciona en un 50 por ciento el desarrollo de dicha enfermedad(AU)

Introduction: Arterial hypertension, due to its influence and multisystemic involvement, emerges as a potential risk factor for the progressive deterioration of cognitive functions. Objective: To identify the main cognitive alterations associated with arterial hypertension, specifically in attention and memory. Methods: A retrospective literature review of 34 studies was carried out, taking into account inclusion criteria. A time window was established from 2002 to 2019, including the PUBMED, SCOPUS, MEDLINE and SCIELO databases. The full texts were subjected to critical reading and documental analysis using a tracking matrix. Conclusions: One of the most important consequences of this disease is the negative impact on cognitive functions, particularly attention and memory, with an incidence in mild, profound and medium cognitive impairment. However, its impact on cognition is an area that has recently aroused interest in neuropsychology and cognitive neuroscience. Arterial hypertension is considered one of the cardiovascular diseases linked to dementia, since it causes the development of this disease in 50 percent of cases(AU)

Research progress in atrial fibrillation with cerebral small vessel disease / 中南大学学报(医学版)

Non-valvular atrial fibrillation is a common arrhythmia and a major risk factor for cardioembolic stroke. Small cerebral vascular disease is a syndrome of clinical, cognitive, imaging, and pathological manifestations caused by intracranial small vascular lesions. The imaging findings on cranial magnetic resonance usually shows recent subcortical small infarction, vascularised lacunae, white matter hypersignal, perivascular space enlargement, cerebral microhemorrhage, and brain atrophy. It is a major cause of neurological loss and cognitive function decline in the elderly. Current studies suggest that atrial fibrillation may increase the imaging load of cerebral small vessel disease through a series of mechanisms such as microembolization, hypoperfusion, inflammation, endothelial dysfunction, and lymphoid system dysfunction. The imaging of cerebral small vessel disease with atrial fibrillation has a potential relationship with cognitive function decline and is related to the occurrence and prognosis of stroke, even more has a potential role in suggesting the etiology and secondary prevention strategies of ischemic stroke.

The influencing factors of cognitive impairment in patients with silicosis / 中华劳动卫生职业病杂志

Objective: To explore the influencing factors of cognitive impairment in patients with silicosis, and to analyze the effect of brain-derived neurotrophic factor (BDNF) on cognitive function. Methods: In March 2021, 484 silicosis patients from April 2018 to April 2020 were included in the study. The Montreal Cognitive Assessment Scale of Chinese version was used to evaluate their cognitive function, and they were divided into the cognitive impairment group (n=282) and the non cognitive impairment group (n=202) , another 30 healthy persons from body check were served as control group. The concentrations of BDNF were compared between the three groups. And the receiver operating characteristic (ROC) curve was drawed to analyze the value of BDNF in predicting cognitive impairment in silicosis patients. And the logistic regression analysis was used to explore the risk factors of cognitive impairment. Results: The incidence of cognitive impairment in silicosis patients was 58.26% (282/484) . The level of BDNF in the cognitive impairment group[ (10.32±2.11) mg/L] was significantly lower than that in the non cognitive impairment group[ (13.43±3.45) mg/L] (t=-12.27, P<0.001) . The results of ROC curve analysis showed that the area unde the curve of BDNF in predicting cognitive impairment of silicosis patients was 0.763 (95%CI: 0.613-0.874, P=0.024) , the cut off value was 10 mg/L, the sensitivity was 0.88, and the specificity was 0.84. Logistic regression analysis showed that the level of BDNF (≤10 mg/L) , age (≥65 years old) , course of disease (≥5 years) and diabetes mellitus were the risk factors of cognitive impairment in silicosis patients (OR=2.346, 95%CI: 1.654-3.103; OR=1.757, 95%CI: 1.214-1.998; OR=1.346, 95%CI: 1.112-1.564; OR=1.165, 95%CI: 1.102-1.542, P=0.001, 0.012, 0.027, 0.036) . Conclusion: BDNF may be one of the indicator to predict the risk of cognitive impairment in patients with silicosis.

Digoxin Ameliorates Glymphatic Transport and Cognitive Impairment in a Mouse Model of Chronic Cerebral Hypoperfusion / 神经科学通报·英文版

The glymphatic system plays a pivotal role in maintaining cerebral homeostasis. Chronic cerebral hypoperfusion, arising from small vessel disease or carotid stenosis, results in cerebrometabolic disturbances ultimately manifesting in white matter injury and cognitive dysfunction. However, whether the glymphatic system serves as a potential therapeutic target for white matter injury and cognitive decline during hypoperfusion remains unknown. Here, we established a mouse model of chronic cerebral hypoperfusion via bilateral common carotid artery stenosis. We found that the hypoperfusion model was associated with significant white matter injury and initial cognitive impairment in conjunction with impaired glymphatic system function. The glymphatic dysfunction was associated with altered cerebral perfusion and loss of aquaporin 4 polarization. Treatment of digoxin rescued changes in glymphatic transport, white matter structure, and cognitive function. Suppression of glymphatic functions by treatment with the AQP4 inhibitor TGN-020 abolished this protective effect of digoxin from hypoperfusion injury. Our research yields new insight into the relationship between hemodynamics, glymphatic transport, white matter injury, and cognitive changes after chronic cerebral hypoperfusion.

Parkinson's disease and periodic limb movement in sleep / Doença de Parkinson e movimentos periódicos dos membros durante o sono

Parkinson's disease is a neurodegenerative disease understood as a complex syndrome with motor and non-motor symptoms, including sleep-related conditions, such as periodic limb movements in sleep (PLMS). This paper presents issues regarding Parkinson's disease, motor and non-motor symptoms, sleep physiology, and PLMS. In conclusion, both conditions seem to be correlated through impairment of the dopaminergic system.

A doença de Parkinson é uma doença neurodegenerativa entendida como uma síndrome complexa com sintomas motores e não motores, incluindo condições relacionadas ao sono, como movimentos periódicos dos membros durante o sono (MPMS). Este artigo apresenta questões relacionadas à doença de Parkinson, sintomas motores e não motores, fisiologia do sono e MPMS. Em conclusão, ambas as condições parecem estar correlacionadas por comprometimento do sistema dopaminérgico.

Factores asociados a bajo rendimiento cognitivo en adultos con sospecha de apnea obstructiva del sueño / Factors associated with low cognitive performance in adults with suspected obstructive sleep apnea

La apnea obstructiva del sueño (AOS) se ha asociado a deterioro cognitivo. OBJETIVO: Identificar factores asociados a bajo rendimiento cognitivo (BRC) en adultos con sospecha de AOS. MÉTODO: Se realizó evaluación cognitiva empleando la Evaluación Cognitiva de Montreal (MoCA); se consideró BRC un puntaje inferior a 21. El diagnóstico de AOS fue mediante poligrafía respiratoria de 5 canales, según índice de apnea-hipopnea (IAH). Se evaluó también calidad de sueño, síntomas depresivos, entre otros. RESULTADOS: En 91,5% de 320 pacientes consecutivos se confirmó el diagnóstico de AOS. El promedio de MoCA fue 20,6 puntos. El grupo con BRC tenía mayor edad, menor escolaridad; mayor frecuencia de hipertensión arterial y diabetes mellitus, y desaturaciones de la oxihemoglobina de mayor magnitud. No hubo diferencias de gravedad según IAH entre ambos grupos. COMENTARIO: Los pacientes con BRC presentan factores de riesgo asociados a deterioro cognitivo, y mayor magnitud de desaturaciones de la oxihemoglobina.

Obstructive sleep apnea (OSA) has been associated with cognitive decline. OBJECTIVE: To identify factors associated with low cognitive performance (LCP) in adults with suspected OSA. MATHOD: Cognitive evaluation was performed using Montreal Cognitive Assessment (MoCA), and scores lower than 21 were considered LCP. The diagnosis of OSA was made using 5-channel respiratory polygraphy, according to the apnea-hypopnea index (AHI). Sleep quality, depressive symptoms, among others, were also evaluated. RESULTS: In 91.5% of 320 consecutive patients the diagnosis of OSA was confirmed. The MoCA average was 20.6 points. The group with LCP was older, less educated, were more likely to have hypertension and diabetes mellitus, and with more severe oxyhemoblobin desaturations. There were no differences in severity according to AHI between both groups. COMMENT: Patients with LCP have risk factors associated with cognitive impairment, besides more severe oxyhemoglobin desaturations.

Factores de riesgo cardiometabólico y funcionamiento cognitivo: el rol de la reserva cognitiva / Association between cardiometabolic risk and cognitive impairment

Background: Several risk factors are associated with cognitive impairment in older people, but little attention has been paid to cardiometabolic variables, as well as how cognitive reserve can mediate this association. Aim: To determine the association of cardiometabolic risk factors with cognitive functioning and whether the cognitive reserve mediates this association. Material and Methods: A cross-sectional study with 300 participants with a median age of 56 years (53% male) was conducted. Participants had a cognitive functioning assessment. Fasting glucose, HDL-cholesterol, and blood pressure were measured. Results: A Structural Equation Modeling, revealed a direct effect of cardiometabolic latent risk factors on both a cognitive functioning (β = -.204; p = .056), and cognitive reserve factors (β = -.236, p = .04). Cognitive reserve was directly associated with cognitive functioning (β = .327, p = .01), but did not mediate the association between the cardiometabolic risk factors and cognitive functioning (β = .077, p = .07). The overall goodness of fitness was excellent χ2 (50) = 58.357, p = .195, comparative fit index = .980, Tucker-Lewis Index = .974, root mean square error of approximation = .023 and Standardized Root Mean Square Residual = .041. Conclusions: A direct effect of cardiometabolic risk factors on cognitive functioning was observed.

Older adults with epilepsy: memory complaints and objective neuropsychological performance / Idosos com epilepsia: queixa de memória e desempenho neuropsicológico objetivo

ABSTRACT Introduction: People with epilepsy frequently complain of poor memory. Objective: To assess the occurrence of memory complaints in older adults with epilepsy (OAE) and whether it is associated with clinical variables, objective cognitive performance, and quality of life (QoL). Methods: The Memory Complaint Questionnaire (MAC-Q) was related to objective cognitive performance, the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Quality of Life in Epilepsy Inventory (QOLIE-31), and the clinical characteristics of 83 OAE. Results: OAE showed worse cognitive performance and higher MAC-Q scores when compared to a similar control group (n=40). Impairment in multiple cognitive domains occurred in 34 (41%) OAE and was associated with older age and lower educational level. Memory complaints (MAC-Q≥25) were reported by 45 (54.2%) OAE and associated with older age, lower educational level, onset at ≥60 years, higher NDDI-E scores, lower QOLIE-31 scores, and impairment in multiple cognitive domains. Conclusions: OAE presented worse cognitive performance and greater memory complaints. Episode onset at ≥60 years of age was associated with complaints, but not with objective cognitive deficit. We found an association between subjective and objective cognitive performance, with aspects of epilepsy and worse QoL scores.

RESUMO Introdução: A queixa de memória fraca é frequente em pessoas com epilepsia. Objetivo: Avaliar a ocorrência de queixas de memória em idosos com epilepsia (IE) e se há associação com variáveis clínicas, desempenho cognitivo objetivo e qualidade de vida (QV). Métodos: O questionário de queixa de memória (memory complaint questionnaire — MAC-Q) foi relacionado ao desempenho cognitivo objetivo, o inventário de depressão de transtornos neurológicos para epilepsia (neurological disorders depression inventory for epilepsy — NDDI-E), o QOLIE-31 e com as características clínicas de 83 IE. Resultados: Houve desempenho cognitivo inferior e maiores escores no MAC-Q em IE quando comparados aos de um grupo controle similar (n=40). Comprometimento de múltiplos domínios cognitivos ocorreu em 34 (41%) IE e associou-se a maior idade e menor escolaridade. Queixas de memória (MAC-Q≥25) foram observadas em 45 (54,2%) IE e associadas a idade mais elevada, menor escolaridade, início das crises aos ≥60 anos, maiores escores no NDDI-E, menores escores no QOLIE-31 e comprometimento de múltiplos domínios cognitivos. Conclusões: Pior desempenho cognitivo e maiores queixa de memória ocorreram em IE. Crises com início aos ≥60 anos foram associadas a queixas, mas não a déficit objetivo cognitivo. Houve associação entre desempenho cognitivo subjetivo e objetivo, com aspectos da epilepsia e pior QV.

Olfactory impairment and the risk of cognitive decline and dementia in older adults: a meta-analysis / Distúrbio olfativo e o risco de declínio cognitivo e demência em idosos: uma metanálise

Abstract Introduction The prediction of the impact of olfactory impairment on cognitive decline in older adults has been different among different age groups. Objective This meta-analysis sought to estimate the predictive power of olfactory impairment on cognitive decline during follow-up in older adults of different ages. Material and methods A medical literature search was carried out using these databases for eligible studies: MEDLINE, COCHRANE and EMBASE. Studies recording olfaction and cognition detection at the beginning and end of the follow-up were included in the preliminary screening. The medical records of older adults without cognitive impairment at the beginning of the follow-up were taken into account in this analysis. Raw data was extracted in order to estimate the relative risk and the corresponding 95% confidence interval (95% CI). Subgroup analysis of age was performed to eliminate the effect of age on the results. Statistical heterogeneity was measured using the I 2 index and Cochran's Q test. Results Eight studies were enrolled in this analysis (3237 events and 13165 participants), and the pooled relative risk for the 70-80 years old subgroup was 2.00 (95% CI = 1.79-2.23). Conclusion Relatively, there is a higher risk of cognitive impairment at the end of follow-up in younger adults with olfactory impairment at the beginning of follow-up. The length of follow-up has a little effect on the relative risk.

Resumo Introdução A previsão do impacto do comprometimento olfativo no declínio cognitivo em idosos tem sido distinta entre diferentes faixas etárias. Objetivo Esta metanálise buscou estimar o poder preditivo do comprometimento olfativo no declínio cognitivo durante o seguimento em idosos de diferentes idades. Material e métodos Foi feita uma pesquisa na literatura médica nos seguintes bancos de dados para estudos elegíveis: Medline, Cochrane e Embase. Os estudos que registraram olfação e detecção de cognição no início e no fim do seguimento foram incluídos na triagem preliminar. Os prontuários médicos de idosos sem comprometimento cognitivo no início do seguimento foram considerados nessa análise. Os dados brutos foram extraídos para estimar o risco relativo e o intervalo de confiança de 95% (IC95%) correspondente. A análise de subgrupos da idade foi feita para eliminar o efeito da idade nos resultados. A heterogeneidade estatística foi medida utilizando o índice I2 e o teste Q de Cochran. Resultados Oito estudos foram incluídos nesta análise (3.237 eventos e 13.165 participantes) e o risco relativo combinado para o subgrupo de 70 a 80 anos foi de 2,00 (IC95% = 1,79-2,23). Conclusão Relativamente, existe um risco maior de comprometimento cognitivo no fim do seguimento em adultos mais jovens que se se apresentam com comprometimento olfativo no início do seguimento. A duração do seguimento tem um pequeno efeito no risco relativo.

Influência da modalidade dialítica na cognição: uma revisão integrativa / Influence of the dialysis modality in cognition: an integrative review

A doença renal crônica é uma condição clínica caracterizada pela queda progressiva da função renal, interferindo na homeostase de todo o corpo, incluindo o sistema nervoso central. Nesses pacientes, o comprometimento cognitivo é um achado comum, em comparação com a população geral, e mais frequente nos pacientes em diálise. O objetivo deste estudo foi identificar, por meio de revisão integrativa, se há diferença entre a modalida- de dialítica (hemodiálise e diálise peritoneal) e a presença de comprometimento cognitivo nesses pacientes. Foi feito levan- tamento bibliográfico nas plataformas PubMed® e Bireme, com buscas padronizadas de 2014 até abril de 2019, utilizando-se pa- lavras-chave. Para a seleção e a avaliação dos estudos científicos levantados, foram estabelecidos critérios, contemplando os seguintes aspectos: autor, ano/local, grau de recomendação/ nível de evidência científica, amostra, faixa etária, média de idade em anos, métodos de avaliação, resultados e conclusão. Dos 561 artigos encontrados, 365 foram excluídos pela data de publicação, 87 foram excluídos pelo título, 17 pelo resumo, 49 pela leitura do artigo, 36 eram repetidos e oito foram selecio- nados para o estudo. Os pacientes em diálise peritoneal apre- sentaram menor comprometimento cognitivo e menor risco para demência que os pacientes em hemodiálise.

Chronic kidney disease is a clinical condition characterized by progressive decline in renal function, interfering with whole-bo- dy homeostasis, including the central nervous system. Cognitive impairment is a common finding in these patients, compared to the general population, besides being more frequent in dialysis patients. The objective of this study was to identify, through an integrative review, if there is difference between the dialysis mo- dality (hemodialysis and peritoneal dialysis) and the presence of cognitive impairment in these patients. A bibliographic search on the PubMed® and Bireme platforms, with standard searches from 2014 to April 2019, using keywords, was conducted. For the selection and evaluation of scientific studies found in the sear- ch, criteria have been established, considering the following as- pects: author, year/location, grade of recommendation/level of evidence, sample, age, mean age in years, evaluation methods, results, and conclusion. Among 561 articles found, 365 were ex- cluded based on the date of publication, 87 based on the title, 17 on the abstract, 48 on the article reading, 36 were repeated, and eight were selected for the study. Patients on peritoneal dialysis have less cognitive impairment and lower risk for dementia than patients on hemodialysis.

Associations of Sarcopenia, Handgrip Strength and Calf Circumference with Cognitive Impairment among Chinese Older Adults / 生物医学与环境科学（英文）

Objective@#To evaluate the associations of sarcopenia, handgrip strength and calf circumference with cognitive impairment among Chinese older adults.@*Methods@#Totally 2,525 older adults were recruited from the Healthy Aging and Biomarkers Cohort Study. Cognitive impairment was assessed by the Chinese Mini-Mental State Examination. Handgrip strength was calculated from the means of the right and left hand values. Calf circumference was measured at the site of maximum circumference of the non-dominant leg. The formula developed by Ishii was used to define sarcopenia. Multiple logistic regression was performed to evaluate the associations of sarcopenia, handgrip strength, and calf circumference with cognitive impairment.@*Results@#The prevalence of cognitive impairment was 34.36%. The adjusted odds ratio ( @*Conclusion@#Sarcopenia, identified by low handgrip strength and low calf circumference, was positively associated with cognitive impairment.

Cognitive impairment in two subtypes of a single subcortical infarction / 中华医学杂志(英文版)

BACKGROUND@#Single subcortical infarction (SSI) is caused by two main etiological subtypes, which are branch atheromatous disease (BAD) and cerebral small vessel disease (CSVD)-related SSI. We applied the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ), the Shape Trail Test (STT), and the Stroop Color and Word Test (SCWT) to investigate the differences in cognitive performance between these two subtypes of SSI.@*METHODS@#Patients with acute SSIs were prospectively enrolled. The differences of MoCA-BJ, STT, and SCWT between the BAD group and CSVD-related SSI group were analyzed. A generalized linear model was used to analyze the associations between SSI patients with different etiological mechanisms and cognitive function. We investigated the correlations between MoCA-BJ, STT, and SCWT using Spearman's correlation analysis and established cut-off scores for Shape Trail Test A (STT-A) and STT-B to identify cognitive impairment in patients with SSI.@*RESULTS@#This study enrolled a total of 106 patients, including 49 and 57 patients with BAD and CSVD-related SSI, respectively. The BAD group performances were worse than those of the CSVD-related SSI group for STT-A (83 [60.5-120.0] vs. 68 [49.0-86.5], P = 0.01), STT-B (204 [151.5-294.5] vs. 153 [126.5-212.5], P = 0.015), and the number of correct answers on Stroop-C (46 [41-49] vs. 49 [45-50], P = 0.035). After adjusting for age, years of education, National Institutes of Health Stroke Scale and lesion location, the performance of SSI patients with different etiological mechanisms still differed significantly for STT-A and STT-B.@*CONCLUSIONS@#BAD patients were more likely to perform worse than CSVD-related SSI patients in the domains of language, attention, executive function, and memory. The mechanism of cognitive impairment after BAD remains unclear.

Cognitive impairment in children with benign childhood epilepsy with centrotemporal spikes and attention deficit hyperactivity disorder: a prospective study / 中国当代儿科杂志

OBJECTIVES@#To study the difference in cognitive impairment between the children with benign childhood epilepsy with centrotemporal spikes (BECT) and attention deficit hyperactivity disorder (ADHD) and those with BECT or ADHD alone.@*METHODS@#A prospective study was performed on 80 children with BECT and ADHD, 91 children with BECT, and 70 children with ADHD , who were diagnosed with the diseases for the first time. Seventy children of the same age who underwent physical examination were enrolled as the healthy control group. Event-related potential P300, Wechsler Intelligence Scale for Children, and integrated visual and auditory continuous performance test were used to measure and compare each index between groups.@*RESULTS@#Compared with the healthy control group, the BECT+ADHD group, the BECT group, and the ADHD group had a significantly prolonged P300 latency, a significant reduction in the amplitude of P300, and significant reductions in the scores of verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), processing speed index (PSI), full scale intelligence quotient (FSIQ), auditory response control quotient (ARCQ), visual response control quotient, full response control quotient (FRCQ), auditory attention quotient (AAQ), visual attention quotient, and full attention quotient (@*CONCLUSIONS@#Compared with the children with BECT or ADHD alone, the children with both BECT and ADHD have basically the same fields of cognitive impairment but a higher degree of cognitive impairment in some fields.

Feature of cognitive dysfunction in patients with temporal lobe epilepsy and its clinical influencing factors / 中南大学学报(医学版)

OBJECTIVES@#To comprehensively analyze the characteristics of cognitive impairment of temporal lobe epilepsy (TLE), and to explore the effects of different lateral patients' cognitive impairment and different clinical factors on cognitive impairment of TLE.@*METHODS@#A total of 84 patients, who met the diagnostic criteria for TLE in the Department of Neurology, Xiangya Hospital, were collected as a patient group, with 36 cases of left TLE and 48 cases of right TLE. A total of 79 healthy volunteers with matching gender, age and education level were selected as a control group. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the scores of Arithmetic Test, Information Test, Digit Symbol Substitution Test (DSST), Block Design Test (BDT), Hayling Test and Verbal Fluency Test (VFT) of the revised Chinese Adult Wechsler Intelligence scale were retrospectively analyzed in the 2 groups.Multiple regression analysis was used to analyze the relationship between the clinical factors and the cognitive impairment score.@*RESULTS@#Compared with the control group, the TLE patient group had low scores in all neuropsychological tests, with significant difference (all @*CONCLUSIONS@#There are multiple cognitive domain dysfunctions in TLE, including language, short-term memory, long-term memory, attention, working memory, executive function and visual space function. Left TLE has greater impairment of executive function and right TLE has greater damage in working memory. Long pathography of disease, hippocampal sclerosis and a history of febrile convulsions may lead to more severe cognitive impairment. Earlier identification and earlier intervention are needed to improve prognosis of patients.

The effect of the 2018 Japan Floods on cognitive decline among long-term care insurance users in Japan: a retrospective cohort study

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.

S100B level and cognitive dysfunction after robotic-assisted laparoscopic radical prostatectomy procedures: a prospective observational study / Nível de S100B e disfunção cognitiva após prostatectomia radical laparoscópica assistida por robô: estudo observacional prospectivo

Abstract Background: The present study investigated the association between Postoperative Cognitive Dysfunction (POCD) and increased serum S100B level after Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP). Methods: The study included 82 consecutive patients who underwent RALRP. Serum S100B levels were determined preoperatively, after anesthesia induction, and at 30 minutes and 24 hours postoperatively. Cognitive function was assessed using neuropsychological testing preoperatively, and at 7 days and 3 months postoperatively. Results: Twenty four patients (29%) exhibited POCD 7 days after surgery, and 9 (11%) at 3 months after surgery. Serum S100B levels were significantly increased at postoperative 30 minutes and 24 hours in patients displaying POCD at postoperative 7 days (p = 0.0001 for both) and 3 months (p = 0.001 for both) compared to patients without POCD. Duration of anesthesia was also significantly longer in patients with POCD at 7 days and 3 months after surgery compared with patients without POCD (p = 0.012, p = 0.001, respectively), as was duration of Trendelenburg (p = 0.025, p = 0.002, respectively). Composite Z score in tests performed on day 7 were significantly correlated with duration of Trendelenburg and duration of anesthesia (p = 0.0001 for both). Conclusions: S100B increases after RALRP and this increase is associated with POCD development. Duration of Trendelenburg position and anesthesia contribute to the development of POCD. Trial Registry Number: Clinicaltrials.gov (N° NCT03018522).

Resumo Introdução: O presente estudo investigou a associação entre Disfunção Cognitiva Pós-Operatória (DCPO) e aumento do nível sérico de S100B após Prostatectomia Radical Laparoscópica Assistida por Robô (PRLAR). Métodos: O estudo incluiu 82 pacientes consecutivos submetidos à PRLAR. Os níveis séricos de S100B foram determinados: no pré-operatório, após indução anestésica, e aos 30 minutos e 24 horas do pós-operatório. A função cognitiva foi avaliada com testes neuropsicológicos no pré-operatório, no 7° dia pós-operatório (7 DPO) e aos 3 meses após a cirurgia (3 MPO). Resultados: Observamos 24 pacientes (29%) com DCPO no 7 DPO e 9 pacientes com DCPO (11%) após 3 meses da cirurgia. Quando comparados com os pacientes sem DCPO, os níveis séricos de S100B estavam significantemente aumentados aos 30 minutos e às 24 horas do pós-operatório nos pacientes que apresentaram DCPO no 7 DPO (p= 0,0001 para os dois momentos) e 3 meses após a cirurgia (p= 0,001 para os dois momentos) A duração anestésica também foi significantemente maior em pacientes com DCPO no 7 DPO e 3 MPO em comparação com pacientes sem DCPO (p= 0,012, p= 0,001, respectivamente), assim como a duração da posição de Trendelenburg (p= 0,025, p= 0,002, respectivamente). O escore Z composto nos testes realizados no 7 DPO foi significantemente correlacionado com a duração da posição de Trendelenburg e a duração da anestesia (p= 0,0001 para ambos). Conclusão: S100B aumenta após PRLAR e o aumento está associado ao desenvolvimento de DCPO. A duração anestésica e o tempo decorrido em posição de Trendelenburg contribuem para o desenvolvimento de DCPO. Número de registro do estudo: Clinicaltrials.gov (n° NCT03018522)

Fisher Grading Scale and Cognitive Deficits ­ Literature Review

Subarachnoid hemorrhage (SAH) accounts for 5 to 10% of all types of stroke, with rupture of brain aneurysms being related to deficits in memory, executive functions, and language. Changes in brain functions appear to be related to the presence of blood in the subarachnoid space, and the Fisher Scale (FS) correlates the amount of blood identified on computed tomography (CT). This paper presents a literature review of the association of FS with cognitive deficits secondary to aneurysmal subarachnoid hemorrhage (aSAH), using PubMed. The attempt to correlate the amount of blood identified in the CT with the development of cognitive alterations presents conflicting data. It was evidenced that some of the studies did not perform cognitive tests, or did not show differences between the scores of FS due to sample difficulty. The FS, even with its limitations and imperfections, seems to be a safe and easily reproducible way to predict neurological, cognitive or neuropsychological deficits, in view of its routine use when analyzing patients with aSAH.

Evolución y secuelas cognitivas en un paciente con encefalopatía por VIH/SIDA con tratamiento antirretroviral / Evolution and cognitive consequences in a patient with HIV/AIDS encephalopathy with antiretroviral treatment

El VIH/SIDA es una enfermedad neurotrópica que afecta al sistema nervioso central y dependiendo de la fase clínica de la enfermedad genera deterioro neurológico, psiquiátrico y neuropsicológico en grado variable. Se describe el caso de un paciente que presentó un cuadro de deterioro cognitivo severo (demencia SIDA) con posterior mejoría de signos y síntomas, y establecimiento posterior de secuelas neuropsicológicas después de un año de su diagnóstico. Se comparó una evaluación neuropsicológica en etapa de deterioro cognitivo severo con otra de seguimiento, realizada un año después de iniciar el tratamiento antirretroviral. Se presentan las características clínicas del paciente utilizando el estudio de caso como herramienta metodológica y sobre la base de un procedimiento clínico y psicométrico.

HIV/AIDS is a neurotropic disease that affects the central nervous system and depending on the clinical phase of the disease generates neurological, psychiatric and neuropsychological impairment to varying degrees. The case of a patient who presented severe cognitive impairment (AIDS dementia) is described with subsequent remission of signs and symptoms, and establishment of neuropsychological sequelae after one year of diagnosis. A neuropsychological evaluation in stage of severe cognitive impairment was compared with another follow-up one year after initiating antiretroviral treatment. The clinical characteristics of the patient are presented using the case study as a methodological tool and based on a clinical and psychometric procedure.