The effect of Covid-19 isolation measures on the cognition and mental health of people living with dementia: a rapid systematic review of one year of evidence.

BackgroundCovid-19 control policies have entailed lockdowns and confinement. Although these isolation measures are thought to be particularly hard and possibly harmful to people with dementia, their specific impact during the pandemic has not yet been synthesised. We aimed to examine and summarise the global research evidence describing the effect of Covid-19 isolation measures on the health of people living with dementia. MethodWe searched Pubmed, PsycINFO and CINAHL up to February 2021 for peer-reviewed quantitative studies of the effects of isolation measures during Covid-19 on cognitive, psychological and functional symptoms of people with any kind of dementia or mild cognitive impairment. We summarised the findings of included papers following current guidelines for rapid reviews. ResultsWe identified 15 eligible papers, examining a total of 6,442 people with dementia. 13/15 were conducted in people living in the community and 2 in care homes. 60% (9/15) studies reported changes in cognition with 77% (7/9) of them describing declined cognition by >50% of respondents. 93% (14/15) of studies reported worsening or new onset of behavioural and psychological symptoms. 46% (7/15) studies reported changes in daily function, 6 of them reporting a functional decline in a variable proportion of the population studied. ConclusionLockdowns and confinement measures brought about by the pandemic have damaged the cognitive and psychological health and functional abilities of people with dementia across the world. It is urgent that infection control measures applied to people with dementia are balanced against the principles of non-maleficence. This systematic review makes 4 specific calls for action. Key PointsO_LINeuropsychiatric symptoms of people with dementia (e.g., anxiety, depressive symptoms, apathy, agitation) were found to worsen during lockdown in the majority of studies. C_LIO_LICognitive decline affecting memory, orientation concentration and communication was observed by caregivers within few weeks after lockdown. C_LIO_LIThe deterioration reported occurred in a short window of time (between 1 and 4 months) and it is unlikely to be attributable to the natural variation of the course of dementia. C_LIO_LIThere is little research conducted in care home residents with dementia (only 2 papers found). C_LIO_LIIncrease consumption of antipsychotics and benzodiazepines has occurred in people with dementia during lockdown. C_LIO_LIEvidence indicates that isolation measures quickly damaged peoples with dementia cognitive and mental health and probably accelerated overall decline. C_LI

P300 in mesial temporal lobe epilepsy and its correlation with cognition - A MEG based prospective case-control study.

PURPOSE: To assess the role of P300 in patients with temporal lobe epilepsy (TLE) with unilateral hippocampal sclerosis (HS) using magnetoencephalography (MEG) based auditory and visual oddball tasks, and to assess its correlation with neuropsychological tests. METHODS: Thirty-patients (M:F-17:13, onset-11.77 ±â€¯8.75 years, duration-16.10 ±â€¯9.61 years) with TLE-HS (Left:15, Right:15) and fifteen-healthy age, gender and years of education matched controls (M:F-10:5, age-28.13 ±â€¯4.76 years) underwent auditory and visual oddball tasks in MEG and cognition assessment using Indian Council of Medical Research (ICMR)-cognitive test battery. Independent component analysis (ICA) was applied to the magnetic evoked field responses for the detection of the P300 component. Source localization of P300 was performed with Classical LORETA Analysis Recursively Applied (CLARA). The latency and amplitude of P300 were estimated and subsequently correlated with cognitive scores. RESULTS: The visual P300 amplitude in the TLE group was lower when compared to the control group. In subgroup comparison (controls vs. right HS vs. left HS), visual P300 amplitudes were lower in the right HS group compared to both left HS and control groups (p-value = 0.014). On the other hand, no significant difference for auditory P300 latency or amplitude was noted between patients and controls as well as between subgroups. A negative correlation found between the MEG visual P300 amplitude and Indian Trial Making Test (TMT)-B duration in the patient group. CONCLUSION: Patients with TLE-HS have decreased visual-P300 amplitude. A significant correlation found between visual P300 amplitude and cognitive tests of visuospatial attention and working memory. Overall, MEG based visual P300 amplitude can be further explored with large sample size studies to establish as a complementary objective test for cognitive assessment in TLE.

Pre-operative and post-operative cognitive deficits in patients with supratentorial meningiomas.

OBJECTIVES: Cognitive deficits caused by extra-axial benign brain tumors like meningiomas and the course of these deficits after surgery is not well known. The aim of the study is to assess the pre-operative and post-operative cognitive functions in patients with meningiomas in the supratentorial compartment. MATERIALS AND METHODS: In this prospective study, patients with clinico-radiological diagnosis of supratentorial meningioma, operated upon and later confirmed by histopathological examination, were included. The patients were evaluated for cognitive deficits before and after surgery. The various clinical and radiological factors influencing the cognitive status were evaluated. RESULTS: A total of 57 patients were enrolled into the study. Out of 57, 22 were males and 35 were females. The frontal group had 22 patients, the parietal group had 10 patients, the temporal group had 10 patients, the occipital group had 6 patients, and the suprasellar group had 9 patients. Meningiomas, although extra-axial, caused significant cognitive deficits in 42 patients (73.7%). The highest frequency of cognitive deficits is seen in the frontal and temporal group of meningiomas (90% each). Frontal meningiomas with volume greater than 35 cc and peritumoral edema greater than 40 cc caused a higher frequency of cognitive deficits. Also, patients with raised ICP had significant cognitive deficits. Postoperatively there was a significant improvement in the cognitive functions in the frontal and temporal groups. CONCLUSION: Meningiomas cause cognitive deficits in 73.7% of patients. Anatomical location of meningioma, elevated ICP, the volume of meningioma and extent of peritumoral edema significantly influence the incidence of cognitive deficits. Post-operatively, the cognitive deficits improve significantly in the frontal and temporal group.

Clinical outcome of Guillain-Barré syndrome with various treatment methods and cost effectiveness: A study from tertiary care center in South India: Yashoda GBS Registry

Back ground and Objective: Both plasmapheresis and intra venous immunoglobulin (IVIG) are effective for Guillain-Barré syndrome (GBS) but differ in cost and ease of administration. The aim of this study was to evaluate and compare clinical outcome after treatment with IVIg and plasmapheresis in patients with various GBS subtypes and assess their cost effectiveness. Methods: Thirty seven consecutive GBS patients, recruited from May 2008 to September 2012, from Department of Neurology, Yashoda hospital Hyderabad, underwent detailed clinical and electrophysiological assessment. Patients randomly received either IVIG or plasmapheresis. Outcome was measured using change in mean motor power and Hughes grade at discharge. Effectiveness and duration of hospital stay was compared with cost effectiveness of both therapies. Results: Out of 37 patients; men were 23 (62.1%), mean age was 42.3 +14.1 years. Electro physiologically acute inflammatory demyelinating neuropathy (AIDP) was most common (56.7%). Nineteen patients (51.3%) received IVIG and plasmapheresis was done in 18 (48.6%). Cost of plasmapheresis was significantly lower (mean USD 2,584.5 versus USD 4,385.3) (p=0.01). At discharge, significant and similar improvement was noted in both groups although duration of hospital stay was longer in plasmapheresis group Three patients (2 in plasmapheresis and one in IVIG group) died. Conclusion: In developing countries, plasmapheresis may be a better option in treatment of GBS.

Serum 25-Hydroxyvitamin D Deficiency in Ischemic Stroke and Subtypes in Indian Patients / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Vitamin D deficiency is common across all age groups and may contribute to cardiovascular diseases. Serum 25-hydroxyvitamin D deficiency causing ischemic stroke has been documented in recent reports. AIM: To investigate the association of serum 25-hydroxyvitamin D deficiency with ischemic stroke and subtypes. METHODS: We recruited 250 consecutive ischemic stroke patients and 250 age and sex matched controls attending the Department of Neurology, at Yashoda hospital, Hyderabad, India, from January 2011 to December 2012. All ischemic stroke patients underwent stroke subtyping. We measured 25-hydroxyvitamin D by chemiluminescence test, serum calcium, phosphorus, alkaline phosphatase, and C-reactive protein (CRP) in cases and controls. RESULTS: Out of 250 stroke patients, 190 (76%) were men and mean age was 58.4+/-11.1 years (age range-26-89 years). 25-hydroxyvitamin D deficiency was observed in 122 (48.8%) stroke patients and 79 (31.6%) controls (P=0.001). Among stroke patients, serum 25-hydroxyvitamin D deficiency was found in 54.9% (50/91) of patients with large artery atherosclerosis, 54% (20/37) in cardioembolic stroke, 44.4% (20/45) in small artery diseases, 42.8% (15/35) in stroke of other determined etiology and 40.4% (17/42) in stroke of un-determined etiology. Multiple logistic regression analysis showed an independent association of 25-hydroxyvitamin D deficiency with ischemic stroke (odds ratio: 1.6; 95% CI 1.2-2.8). The association was strongest with large artery atherosclerosis (odds ratio: 2.4; 95% CI 1.6-3.5) and cardioembolic stroke (odds ratio: 2.0; 95% CI 1.0-3.2). CONCLUSIONS: We found that 25-hydroxyvitamin D deficiency had an independent association with ischemic stroke. The association was established in large artery arthrosclerosis and cardioembolic stroke.

Use of thrombolytic therapy in cerebral venous sinus thrombosis with ulcerative colitis.

Cerebral venous thrombosis developing concurrently with active ulcerative colitis poses a therapeutic dilemma. We report the case of a 31-year-old woman who developed dural venous sinus thrombosis during the course of active ulcerative colitis in whom we accomplished clot lysis using intrasinus urokinase. The success of the procedure was assessed by improvement in the patient's neurological condition and resolution of imaging features without any bleeding complications. We also reviewed literature on various modalities of treatment of sinus venous thrombosis in patients with ulcerative colitis and outcome.

Validation of transcranial Doppler with magnetic resonance angiography in acute cerebral ischemia.

BACKGROUND AND PURPOSE: Transcranial Doppler (TCD) is often used as a screening tool for detecting intracranial stenosis. Since TCD results may vary among laboratories and sonographers, it requires validation against an imaging modality. We evaluated diagnostic accuracy of TCD performed in our laboratory against time-of-flight (TOF) magnetic resonance angiography (MRA) in detecting intracranial stenosis in patients with acute cerebral ischemia. METHODS: Consecutive patients with acute (<24 hours) cerebral ischemia and intracranial arterial stenosis on MRA underwent both TCD and MRA within 5 hours of each other. TCD was performed by credentialed neurosonologists according to standardized protocol. An independent neuroradiologist interpreting MRA was blinded to TCD findings. We evaluated TCD peak systolic velocities (PSV) in proximal intracranial arteries as predictive of moderate (>50%) and severe (>70%) stenosis on TOF-MRA. RESULTS: One hundred and fifty patients (74% males; mean age 53 years) underwent neurovascular evaluation with TCD and MRA. Twenty-two (14.6%) patients were excluded due to absent temporal acoustic windows. Middle cerebral artery TCD PSV values of >140 cm/s and >180 cm/s were found to predict a >50% and >70% focal stenosis, respectively. Optimal cut-off PSV values for other major proximal intracranial arteries were also established. CONCLUSIONS: TCD performed in our laboratory shows satisfactory agreement with TOF-MRA in diagnosis and grading of proximal intracranial stenosis in patients with acute cerebral ischemia.

Vascular cognitive impairment.

The term vascular cognitive impairment (VCI) has been proposed to encompass all people with cognitive impairment of cerebrovascular origin. VCI is not a single condition, but has several clinical presentations, etiologies, and treatment. VCI forms a spectrum that includes vascular dementia, mixed Alzheimer's disease with a vascular component, and VCI that does not meet dementia criteria. Multiple pathophysiological mechanisms contribute to VCI, accounting for its heterogeneity. Although main changes in the brain in VCI include cerebral infarcts, vascular cognitive impairment is thought to be due to factors beyond acute infarcts. Cerebral white matter lesions and silent brain infarcts are considered to be risk factors for VCI. The prevalence of VCI is high and this entity is poised to become the silent epidemic of the 21st century. Cognitive impairment due to cerebrovascular disease can to some extent be improved, and VCI prevented, if vascular risk factors are brought under control and strokes do not recur. Therefore, strategies that focus on the prevention and treatment of the cognitive impairment associated with cerebrovascular disease are high priority healthcare objectives.

Hyperhomocysteinemia associated with Chlamydia pneumoniae infection in ischemic stroke: A hospital based study from South India

Background and objective: While Chlamydia pneumoniae infection and hyperhomocysteinemia have been shown to contribute independently to the atherosclerotic risk, recent evidence has linked the association of C. pneumoniae positivity and hyperhomocysteinemia in patients with established atherosclerosis. The aim of this study was to investigate whether such a relationship can be replicated in India, where both infections and hyperhomocysteinemia are prevalent. Methods: Patients of acute ischemic stroke enrolled consecutively and prospectively in the Nizam’s Institute Stroke Registry, Hyderabad, India (NISHI) were subjected to thorough clinical and neuroimaging evaluation. Blood was drawn in fasting state for estimation of homocysteine level and the titers of C. pneumoniae antibodies (IgG and IgA) by microimmunofluorescence method. Results: Of the 200 stroke patients, 72 (36%) were tested positive for C. pneumoniae antibodies, and 128 (64%) tested negative. The percentage of subjects with hyperhomocysteinemia, smoking, hypercholesterolemia and C-reactive protein positivity was higher in C. pneumoniae positive group compared with C. pneumoniae negative group. Multiple logistic regression analysis showed that hyperhomocysteinemia was an independent variable in the C. pneumoniae positive group (Odds ratio 4.71 95% CI 2.2-9.8). Conclusion: This study has shown that C. pneumoniae seropositivity is linked with hyperhomocysteinemia in patients with ischemic stroke in a sample of South Indian population.