Cognitive impairment affects physical recovery of patients with heart failure undergoing intensive cardiac rehabilitation.

Purpose. To determine whether the presence of cognitive impairment (CI) affects physical recovery of patients with chronic heart failure (CHF) undergoing a cardiac rehabilitation program (CRP). Methods. We enrolled 80 CHF patients (M/F = 53/27). CI was evaluated by means of the Mini-Mental State Examination (MMSE), exercise tolerance was evaluated by six-minute walking test (6 mwt). All patients underwent a 6-week CRP program at 50-70% of maximal V(O2). Patients were divided into two groups according to their MMSE (group 1: 16-23; group 2: 24-30). Results. MMSE resulted directly related to ejection fraction (r = 0.42; P = 0.03), and it was inversely related to creatinine (r = -0.36; P = 0.04). At 6 week group 1 had a lower increase in distance walked at 6 MWT than group 2 (P = 0.008). At multivariate logistic regression MMSE 16-23 predicted a reduced exercise recovery in the overall population (OR = 1.84; 95% CI = 1.50-2.18) and in women (OR = 1.42; 95% CI = 1.22-1.75), while it was not predicted in males. Conclusions. CI is a marker of advanced CHF and is an independent predictor of lower exercise recovery after CRP.

Slowing of event-related potentials in primary progressive aphasia. A case report.

Primary Progressive Aphasia (PPA) is a rare and insidious language impairment that worsens over time. It belongs to the group of fronto-temporal dementias. This study was aimed at assessing the role of speed of cognitive abilities, such as word recognition, in PPA. The design is a single-case, longitudinal study. A male patient suffering from PPA was enrolled and fifteen healthy older adults were the control group. An event-related electrical potential connected with word recognition, namely the N400, was delayed by 200 ms at baseline compared to healthy controls and progressively deteriorated. One year later, the delay was greater and two years later the potential had disappeared. Reduced speed of processing is an early pathological factor negatively affecting higher cognitive functions in APP. Event related electrical potentials are recommended in the field of aphasia and cognitive decline. They permit observation of a speed decline in higher cognitive abilities, when pathological changes at a central level begin and language comprehension seems to be unaffected.

Attentional training in elderly subjects affects voluntarily oriented, but not automatic attention: a neurophysiological study.

OBJECTIVES: Our study aimed at investigating the effect of repetitive recordings on somatosensory evoked potentials (SEPs) related to spatial attention in a population of healthy elderly subjects. METHODS: Fifteen healthy elderly subjects were tested for six consecutive days using a somatosensory oddball paradigm, in which target stimuli were applied above the elbow and the non-target stimuli on the ipsilateral shoulder. Brain electrical activity was recorded from six scalp electrodes (Fz, Cz, F3, F4, T3 and T4). RESULTS: The N140 response to target stimuli showed a significantly decreased amplitude across the sessions with the lowest value during the fourth day of recording and with a partial recovery at the sixth day. On the contrary, the amplitude of the N140 response to non-target stimuli and that of the P300 potential to target stimuli were not significantly modified. CONCLUSIONS: The significant amplitude reduction of the N140 potential in target, but not in non-target recordings across sessions, suggests that the voluntarily oriented attention is reduced by stimulus repetition, while the automatic attention is not.

The effects of aging on selective attention to touch: a reduced inhibitory control in elderly subjects?

This article aimed at disclosing differences in the brain mechanisms underlying selective attention between elderly and young subjects. We studied two populations of subjects, 17 elderly (mean age: 71.7) and 12 young (mean age: 26.9). Somatosensory evoked potentials (SEPs) to median nerve stimulation were recorded from 19 scalp electrodes in a neutral condition (NC), in which subjects were asked to disregard the electrical stimulation and in a selective attention condition (SAC), in which the subjects had to count tactile stimuli delivered on the same hand of the stimulated median nerve. In a further 3 old and in 3 young subjects, SEPs were recorded also in a distraction condition (DC), in which the subjects had to perform a mathematical task. The SEP amplitude increase during SAC was lower in old than in young subjects. Moreover, while in young subjects the N140 potential was identifiable only in SAC, in the elderly population it was already evoked during both NC and DC. Elderly subjects are probably unable to divert their attention from the median nerve electric stimuli during NC and DC and, therefore, have lower attention resources to invest during SAC. This may explain the recording of the attention-related N140 potential even in NC and DC and the lower SEP amplitude increase in SAC, observed in elderly subjects. These findings agree with recent hypotheses that suggest a decrease of the inhibitory control of the attention mechanisms during aging.