Comorbid Neurocognitive Impairment in Patients with Epilepsy

Background: Epilepsy is a common chronic non-communicable neurological disorder in which the brain function is impaired. Cognitive function is more frequently impaired in people with epilepsy than in the general population. The neurocognitive outcome of epilepsy in children and adults is vital for social prognosis and quality of life assessment. Cognitive changes in epilepsy have multifactorial etiology, including the epilepsy itself, age at onset, duration of epilepsy, treatment of epilepsy, reaction to epilepsy and any associated brain dysfunction and /or damage. This study was conducted to check association of neurocognitive impairment with the socio-demographic factors and disease associated factors in patients with epilepsy. Methodology: This study was a single centre cross-sectional study in which 96 patients were included. Severity of neurocognitive impairment was measured by Addenbrookes’ Cognitive Examination- R (ACE- R) score. Results: Out of 96 patients, neurocognitive impairment was seen in 23 (23.95%) patients. Conclusions: This study shows that neurocognitive impairment was found to be more when the age at onset of epilepsy was less, when the duration of the illness was more and when frequency of seizure was higher. Conclusion: Neurocognitive impairment is noted in patients with epilepsy and must be treated in the long- term management of epilepsy

A Clinical Analysis of patients seen in a Geriatric Mental Health Camp organized in Mumbai

Background: Geriatric mental health is a neglected domain of mental health and many cases remainundetected in the community. Community programs have often helped to detect many cases of the elderlywith psychiatric problems and help them access care. The current paper aims to present an analysis ofpatients seen in a geriatric health camp from a psychiatric perspective.Methods: 103 elderly attended the geriatric camp and were assessed clinically for psychiatric problems. Theywere also administered the Adenbrooke’s Cognitive Examination Revised (ACE-R) Hindi version, Barthel’sIndex for Activities of Daily Living and 3.Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST). Theresults were analyzed statistically and presented.Results: The mean age of the subjects in the study was 66.05 ± 7.9 years. 83 subjects (79%) out of the 105were female. The mean BIADL score of the sample was 19.52 ± 1.9 and on the basis of scores on the ACER they were classified as having cognitive impairment (n=67) and not having cognitive impairment (n=27).The cognitively impaired group differed from the non-cognitive impairment on all subscales of the ACE-R.55 (52.4%) reported the presence of elder abuse but had taken no action against it. The BIADL scores showeda significant correlation on all aspects of ACE-R scores.Conclusions: Geriatric health camps can serve as a useful arena for the detection of geriatric mental healthproblems. Further studies in larger populations are needed to corroborate the findings seen in the geriatrichealth camp reported in this study

Performance of low-educated elders with depression on Addenbrooke's Cognitive Examination-Revised (ace-r) test / O desempenho no Addenbrooke's Cognitive Examination-Revised (ACE-R) e seus domínios cognitivos em idosos de baixa escolaridade

ABSTRACT. Along with cognitive disorders, depression has been a concern for mental health services due to its highly debilitating effect on the functioning and quality of life of the elderly. However, there is still little understanding of the cognitive alterations resulting from depression or of the difficult differential diagnosis with mild cognitive impairment (MCI). It is known that performance on cognitive tests is strongly influenced by education but few studies have been conducted involving low-educated populations. Objective: To evaluate the performance of elders with low education and no dementia on Addenbrooke's Cognitive Examination-Revised (ACE-R) test and its cognitive domains, and compare patients with Current Major Depressive Episode (CMDE) against those without depressive symptoms. Methods: A retrospective, cross-sectional analytical study was conducted based on medical files of patients treated at the Cerebral Aging Clinic of the Hospital São Lucas of the PUCRS. The study included 116 individuals with low education (< 8 years of education) aged between 60 and 84 (69.6 ± 6.4) years, with MCDE (N = 41) and controls (N = 75). Results: No significant difference was observed between control and MCDE groups in median scores on the ACE-R, Mini-Mental State Examination, and the five cognitive domains. There was also no difference between the groups on separate analyses of results on the clock drawing test, the categorical verbal and phonological fluency test, and the naming test. Conclusion: The results of this study showed that depressive symptoms did not influence scores on the ACE-R tests conducted in elders with low education.

Depressão, juntamente com os transtornos cognitivos, tem sido uma preocupação entre os serviços de saúde mental, devido ao alto índice de prejuízo na funcionalidade e qualidade de vida desta população. Contudo, ainda permanece em aberto a compreensão das alterações cognitivas decorrentes da depressão e de difícil diagnóstico diferencial com o comprometimento cognitivo leve (CCL). Sabe-se que o desempenho nos testes cognitivos é fortemente influenciados pela escolaridade, no entanto, poucos estudos tem sido realizados em populações de muito baixa escolaridade. Objetivo: Avaliar o desempenho no Addenbrooke's Cognitive Examination-Revised (ACE-R) e seus domínios cognitivos em idosos de baixa escolaridade, sem demência, e comparar aqueles que tem diagnóstico de Episódio de Depressão Maior Atual (EDMA), com os que não têm quadro depressivo. Métodos: Estudo transversal analítico, retrospectivo, através dos prontuários dos pacientes atendidos no Ambulatório de Envelhecimento Cerebral (AMBEC) do Hospital São Lucas da PUCRS. Foram incluídos 116 indivíduos com baixa escolaridade (< 8 anos de estudo) e idade entre 60 e 84 anos (69,6 ± 6,7), com EDMA (N = 41) e controles (N = 75). Resultados: Na comparação das médias do ACE-R e os cinco domínios cognitivos, entre o grupo controle e o grupo com EDMA, não foi observada diferença significativa. Também não houve diferença entre os grupos quando analisado separadamente os resultados do teste do relógio, da fluência verbal categórica e fonológica e do teste de nomeação. Conclusão: Como observado neste estudo, os sintomas depressivos não modificam os valores dos testes realizados no ACE-R de idosos com baixa escolaridade.

Screening of cognitive impairment in patients with Parkinson's disease: diagnostic validity of the Brazilian versions of the Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination-Revised / Rastreio de comprometimento cognitivo em pacientes com doença de Parkinson: validade diagnóstica das versões brasileiras da Montreal Cognitive Assessment e do Addenbrooke's Cognitive Examination-Revised

ABSTRACTObjective The aim of the present study is to examine the accuracy of the Brazilian versions of the Montreal Cognitive Assessment (MoCA) and the Addenbrooke's Cognitive Examination-Revised (ACE-R) to screen for mild cognitive impairment (PDMCI) and dementia (PDD) in patients with Parkinson's disease (PD).Method Both scales were administered to a final convenience sample of 79 patients with PD. Patients were evaluated by a neurologist, a psychiatrist and a neuropsychologist using UPDRS, Hoehn and Yahr and Schwab and England scales, global deterioration scale, a psychiatric structured interview, Mattis Dementia Rating Scale and other cognitive tests.Results There were 32 patients with PDMCI and 17 patients with PDD. The MoCA and the ACE-R were able to discriminate patients with PDD from the others.Conclusion Both scales showed to be useful to screen for dementia but not for mild cognitive impairment in patients with PD.

RESUMOObjetivo O objetivo do estudo foi avaliar a acurácia das versões Brasileiras das escalas: Montreal Cognitive Assessment (MoCA) e Addenbrooke's Cognitive Examination-Revised (ACE-R), no rastreamento de comprometimento cognitivo leve (CCL) e demência em pacientes com doença de Parkinson (DP).Método As duas escalas foram aplicadas a uma amostra de conveniência de 79 pacientes com DP. Os pacientes foram avaliados por um neurologista, um psiquiatra e uma neuropsicóloga que utilizaram a UPDRS, a escala de Hoehn e Yahr, a escala de Schwab e England, a escala de deterioração global, uma entrevista psiquiátrica estruturada, a escala de demência de Mattis e outros testes cognitivos.Resultados 32 pacientes foram diagnosticados com CCL e 17 com demência. A MoCA e o ACE-R foram capazes de discriminar pacientes com demência dos demais.Conclusão As duas escalas se mostraram úteis para rastrear demência, mas não CCL, em pacientes com DP.

Difficulties Encountered in Removing a Tibial Intramedullary Nail in a Healed Tibial Fracture / 대한정형외과학회잡지

PURPOSE: The authors report their experience and analyze the risk factors associated with difficulties in the removal of tibial intramedullary nails. MATERIALS AND METHODS: During the period from January 1996 to March 2001, 35 ACE(R) intramedullary nails were removed from healed tibial fractures. The authors analyzed risk factors associated with difficulties in nail removal. The five patients who had difficulties (Group I) were compared with 30 patients who had uneventful removal (Group II) in parameters of age, gender, duration of nail in situ, nail diameter, nail length, and the level of fracture. RESULTS: Younger age of patients (p=0.04) was the only significantly associated risk factors. Gender (p=0.61), the duration of time in situ (p=0.20), nail diameter (p=0.41), the length of nail (p=0.31) and the level of fracture (p=0.22) were not associated risk factors. CONCLUSION: It is suggested that patients undergoing the removal of ACE nails must be warned of possible difficulties that may be encountered.