Cognitive impairment in COPD: a systematic review.

The objectives of this study were to characterize and clarify the relationships between the various cognitive domains affected in COPD patients and the disease itself, as well as to determine the prevalence of impairment in the various cognitive domains in such patients. To that end, we performed a systematic review using the following databases: PubMed, Scopus, and ScienceDirect. We included articles that provided information on cognitive impairment in COPD patients. The review of the findings of the articles showed a significant relationship between COPD and cognitive impairment. The most widely studied cognitive domains are memory and attention. Verbal memory and learning constitute the second most commonly impaired cognitive domain in patients with COPD. The prevalence of impairment in visuospatial memory and intermediate visual memory is 26.9% and 19.2%, respectively. We found that cognitive impairment is associated with the profile of COPD severity and its comorbidities. The articles reviewed demonstrated that there is considerable impairment of the cognitive domains memory and attention in patients with COPD. Future studies should address impairments in different cognitive domains according to the disease stage in patients with COPD.

Cognitive impairment in COPD: a systematic review / Cognitive impairment in COPD: a systematic review

The objectives of this study were to characterize and clarify the relationships between the various cognitive domains affected in COPD patients and the disease itself, as well as to determine the prevalence of impairment in the various cognitive domains in such patients. To that end, we performed a systematic review using the following databases: PubMed, Scopus, and ScienceDirect. We included articles that provided information on cognitive impairment in COPD patients. The review of the findings of the articles showed a significant relationship between COPD and cognitive impairment. The most widely studied cognitive domains are memory and attention. Verbal memory and learning constitute the second most commonly impaired cognitive domain in patients with COPD. The prevalence of impairment in visuospatial memory and intermediate visual memory is 26.9% and 19.2%, respectively. We found that cognitive impairment is associated with the profile of COPD severity and its comorbidities. The articles reviewed demonstrated that there is considerable impairment of the cognitive domains memory and attention in patients with COPD. Future studies should address impairments in different cognitive domains according to the disease stage in patients with COPD.

Os objetivos deste estudo foram caracterizar e esclarecer as relações entre os vários domínios cognitivos afetados em pacientes com DPOC e a doença em si, assim como determinar a prevalência de comprometimentos cognitivos em tais pacientes. Para tanto, foi realizada uma revisão sistemática utilizando as seguintes bases de dados: PubMed, Scopus e ScienceDirect. Os artigos incluídos forneciam informações sobre os comprometimentos cognitivos em pacientes com DPOC. A revisão dos achados de tais artigos mostrou uma relação significativa entre DPOC e comprometimento cognitivo. Os domínios cognitivos mais estudados são a memória e a atenção. Memória verbal e aprendizagem constituem o segundo domínio cognitivo mais comumente prejudicado em pacientes com DPOC. A prevalência de comprometimento da memória visuoespacial e da memória visual intermediária é 26,9% e 19.2%, respectivamente. Observamos que o comprometimento cognitivo está associado ao perfil de gravidade da DPOC e suas comorbidades. A revisão dos artigos demonstrou que há um comprometimento considerável dos domínios memória e atenção em pacientes com DPOC. Investigações futuras devem abordar os comprometimentos em diferentes domínios cognitivos em conformidade com o estágio da doença em pacientes com DPOC.

[Disorders of executive functions. Diagnosis and treatment]. / Trastornos de las funciones ejecutivas. Diagnóstico y tratamiento.

INTRODUCTION: Different contributions to the scientific literature made over the last few decades have confirmed the prefrontal cortex as the neurobiological basis of the executive functions. Today, both the evaluation protocols for carrying out diagnoses and the structuring of the treatment and neurocognitive stimulation plans must interpret each of the prefrontal syndromes (dorsolateral, medial or of the anterior cingulate, and orbitofrontal) involved in the aetiopathogenesis of the different neurodevelopmental and adult disorders in which the executive functions are affected. AIMS: To report on the latest advances in diagnosis and treatment of the executive functions and to stress the importance of identifying and understanding the three syndromes of prefrontal dysfunction in the phase of diagnosis and in neurocognitive rehabilitation. DEVELOPMENT: The authors carry out a review of the literature on the latest advances in neuroscience as regards the neurobiological and neuropsychological foundations of the executive functions and their diagnosis and treatment. CONCLUSIONS: Every day, the scientific community confirms the importance of identifying and understanding the brain circuits in the diagnostic stage, especially the prefrontal dysfunction syndromes involved in the neuropsychological deficits of the different neurodevelopmental and adult disorders, so as to be able to establish effective neurocognitive stimulation protocols.

TITLE: Trastornos de las funciones ejecutivas. Diagnostico y tratamiento.Introduccion. Los diferentes aportes de la literatura cientifica ratifican, desde hace un par de decadas, a la corteza prefrontal como base neurobiologica de las funciones ejecutivas. En la actualidad, tanto los protocolos de evaluacion para la realizacion del diagnostico como la estructuracion de los planes de tratamiento y estimulacion neurocognitiva deben hacer la lectura de cada uno de los sindromes prefrontales (dorsolateral, medial o del cingulo anterior, y orbitofrontal) implicados en la etiopatogenia de los diferentes trastornos del neurodesarrollo y del adulto en los que se ven afectadas las funciones ejecutivas. Objetivos. Exponer los ultimos avances sobre diagnostico y tratamiento de las funciones ejecutivas y resaltar la importancia de identificar y comprender en la fase diagnostica y en la rehabilitacion neurocognitiva los tres sindromes de disfuncion prefrontal. Desarrollo. Se realiza una revision bibliografica sobre los ultimos avances neurocientificos alrededor de las bases neurobiologicas, neuropsicologicas, diagnostico y tratamiento de las funciones ejecutivas. Conclusion. Cada dia la comunidad neurocientifica ratifica la importancia de identificar y comprender en la etapa diagnostica los circuitos cerebrales, especificamente los sindromes de disfuncion prefrontal implicados en los deficits neuropsicologicos de los diferentes trastornos del neurodesarrollo y del adulto para poder establecer protocolos eficaces de estimulacion neurocognitiva.

Characterizing spontaneously reported cognitive complaints: the development and reliability of a classification instrument.

BACKGROUND: The characteristics and associated risks of spontaneously reported cognitive complaints have not been investigated due to the lack of a classification instrument. METHODS: In phase 1, a classification system with descriptive categories and cognitive domains was developed by experts through a modified Delphi technique. In phase 2, 180 elderly patients seeking medical attention for cognitive complaints provided free reports of their cognitive difficulties and each complaint was recorded verbatim. Three observers were asked to classify each complaint into a descriptive category. Perceived cognitive function was further characterized using the Memory Complaint Questionnaire (MAC-Q). RESULTS: The patients reported 493 spontaneous complaints, with a range of 1-6 complaints per patient and a mean of 2.7 (±1.3). The proportion of complaints that could be classified into a category by each of the three observers varied from 91.9% to 95.7%. Inter-observer agreement assessed using the κ statistic varied from 0.79 to 1 for descriptive categories and 0.83 to 0.97 for domains. Compared with the MAC-Q, spontaneously reported complaints provided complementary information by avoiding the cueing effect provoked by the questionnaire. The total number of complaints and their occurrences in specific domains were associated with important sociodemographic and clinical factors, indicating that their meaning and associated risks need to be further investigated. CONCLUSION: The instrument developed in this study proved to be a practical tool for classifying the majority of spontaneously reported cognitive complaints with high reliability. Further studies are needed to investigate clinical usefulness of this approach.

Clinical impact of RehaCom software for cognitive rehabilitation of patients with acquired brain injury.

We describe the clinical impact of the RehaCom computerized cognitive training program instituted in the International Neurological Restoration Center for rehabilitation of brain injury patients. Fifty patients admitted from 2008 through 2010 were trained over 60 sessions. Attention and memory functions were assessed with a pre- and post-treatment design, using the Mini-Mental State Examination, Wechsler Memory Scale and Trail Making Test (Parts A and B). Negative effects were assessed, including mental fatigue, headache and eye irritation. The program's clinical usefulness was confirmed, with 100% of patients showing improved performance in trained functions.

Comparing the clinical usefulness of the Institute of Cognitive Neurology (INECO) Frontal Screening (IFS) and the Frontal Assessment Battery (FAB) in frontotemporal dementia.

We compared the utility of two executive-function brief screening tools, the Institute of Cognitive Neurology (INECO) Frontal Screening (IFS) and the Frontal Assessment Battery (FAB), in their ability to detect executive dysfunction in a group of behavioral variant frontotemporal dementia (bv-FTD, n = 25) and Alzheimer's disease (AD, n = 25) patients in the early stages of their disease and in comparison to a group of age-, gender-, and education-matched controls (n = 26). Relative to the FAB, the IFS showed (a) better capability to differentiate between types of dementia; (b) higher sensitivity and specificity for the detection of executive dysfunction; (c) stronger correlations with standard executive tasks. We conclude that while both tools are brief and specific for the detection of early executive dysfunction in dementia, the IFS is more sensitive and specific in differentiating bvFTD from AD, and its use in everyday clinical practice can contribute to the differential diagnosis between types of dementia.

Functional impairment in bipolar II disorder: is it as disabling as bipolar I?

INTRODUCTION: It is well established that patients with bipolar disorder experience functional impairment even in remission. Nevertheless, bipolar II disorder remains understudied because most investigations to date include only bipolar I patients or just a small sample of bipolar II patients, without explicitly comparing both subtypes of disorder. The main objective of the current report is to evaluate overall and multiple domains of functioning, specifically in bipolar II disorder compared to patients with bipolar I disorder and healthy subjects. METHODS: 233 subjects from 3 groups were compared: bipolar I patients (n=106), bipolar II patients (n=66) and healthy controls (n=61). Bipolar patients meeting criteria of remission were recruited at the Hospital Clinic of Barcelona and at different study sites in Argentina. All participants were assessed with 17-item Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS) and the Functioning Assessment Short Test (FAST). Clinical and sociodemographic data were also recorded. RESULTS: Both subgroups of patients, bipolar I and bipolar II, showed lower overall functioning (p<0.001) and in each domain of the FAST scale (all, p<0.001) when compared to the healthy control group. Tukey post hoc test revealed that bipolar II patients scored worse in the cognitive domain compared to bipolar I patients. However, after controlling for potential confounding variables, this difference disappeared and only older age (p<0.005) and HAM-D scores (p<0.001) remained significant. CONCLUSIONS: Our results suggest that bipolar II patients are as disabled as bipolar I patients. This may be explained, in part, because bipolar II patients experience greater lifetime residual depressive symptoms than the bipolar I subgroup, which may have particular impact on cognitive domains of functioning.

Cognitive components of frontal lobe function in alcoholics classified according to Lesch's typology.

AIMS: This study examined the frontal lobe cognitive function and the mental state among patients with different types of alcohol dependence according to Lesch's typology. METHODS: The frontal assessment battery (FAB) and the mini-mental status examination (MMSE) were given to 170 patients with alcoholism from a Brazilian outpatient service classified by Lesch's typology and to 40 non-alcoholic controls matched for age, gender, socio-demographic characteristics and education. RESULTS: Of the alcoholic sample, 21.2% were classified as Type I, 29.4% as Type II, 28.8% as Type III and 20.6% as Type IV. Alcoholics showed significantly lower overall scores on the MMSE and the FAB as compared to non-alcoholic subjects. Type IV alcoholics had lower MMSE and FAB overall scores as compared to non-alcoholic controls and also to all other types of alcoholic subjects. However, Type II and III subjects with alcoholism also had lower overall FAB scores, but not overall MMSE scores, as compared to non-alcoholic controls. The FAB subsets of motor programming, sensitivity to interference and inhibitory control were significantly reduced in Types II, III and IV alcoholics as compared to non-alcoholic subjects, but only motor programming remained impaired in Type IV alcoholics with preserved mental function. CONCLUSIONS: Executive dysfunctions in alcohol dependence seem to vary depending upon the type of alcoholism. Therefore, the determination of clinical type of alcohol dependence by applying Lesch's typology, along with brief mental state and frontal function examinations, is of clinical relevance in the examination of alcoholics and provides significant clues for more directed forms of alcohol dependence treatment.

Diagnostic transitions in mild cognitive impairment subtypes.

BACKGROUND: At least for a subset of patients, the clinical diagnosis of mild cognitive impairment (MCI) may represent an intermediate stage between normal aging and dementia. Nevertheless, the patterns of transition of cognitive states between normal cognitive aging and MCI to dementia are not well established. In this study we address the pattern of transitions between cognitive states in patients with MCI and healthy controls, prior to the conversion to dementia. METHODS: 139 subjects (78% women, mean age, 68.5 +/- 6.1 years; mean educational level, 11.7 +/- 5.4 years) were consecutively assessed in a memory clinic with a standardized clinical and neuropsychological protocol, and classified as cognitively healthy (normal controls) or with MCI (including subtypes) at baseline. These subjects underwent annual reassessments (mean duration of follow-up: 2.7 +/- 1.1 years), in which cognitive state was ascertained independently of prior diagnoses. The pattern of transitions of the cognitive state was determined by Markov chain analysis. RESULTS: The transitions from one cognitive state to another varied substantially between MCI subtypes. Single-domain MCI (amnestic and non-amnestic) more frequently returned to normal cognitive state upon follow-up (22.5% and 21%, respectively). Among subjects who progressed to Alzheimer's disease (AD), the most common diagnosis immediately prior conversion was multiple-domain MCI (85%). CONCLUSION: The clinical diagnosis of MCI and its subtypes yields groups of patients with heterogeneous patterns of transitions between one given cognitive state to another. The presence of more severe and widespread cognitive deficits, as indicated by the group of multiple-domain amnestic MCI may be a better predictor of AD than single-domain amnestic or non-amnestic deficits. These higher-risk individuals could probably be the best candidates for the development of preventive strategies and early treatment for the disease.

[Mild cognitive impairment: the neuropsychological characteristics of the different subtypes]. / Deterioro cognitivo leve: caracteristicas neuropsicologicas de los distintos subtipos.

AIM: To evaluate the frequency of mild cognitive impairment (MCI) subtypes and their neuropsychological characteristics in our population, and estimate the change in this frequency according to the extension of the neuropsychological examination. PATIENTS AND METHODS: Patients with diagnostic of MCI were included from 01/01/2003 to 31/12/2007. MCI was classified as MCI-amnestic type (MCI-AT), MCI-multiple domain type (MCI-MDT) and MCI-single domain non amnestic (MCI-MNOA). A neuropsychological test was considered abnormal if its result was equal or less than 1.5 standard deviations from what expected for age and educational level. The cohort was divided in short evaluation (less than 14 test, from 2003-2005) and basic-extended evaluation (equal or more than 14 test, from 2006-2007). RESULTS: Out of 204 patients included, 51 (26%) were classified as MCI-AT, 11 (5,4%) as MCI-MNOA and 142 (69,9%) as MCI-MDT. A higher educational level was associated with an increase in the number of MCI-MDT. The longer the evaluation, the greater was the proportion of MCI-MDT and MCI-MNOA and the lower the proportion of MCI-AT, without statistical significance. CONCLUSIONS: The most frequent MCI subtype was MCI-MDT. A more extended evaluation would allow a better classification of MCI subtypes and increase the number of MCI-MDT and MCI-MNOA at the expense of MCI-AT.

Mild cognitive impairment: believe it or not?

Mild cognitive impairment (MCI) was previously defined as a transitional state that can precede dementia, but the condition and the rates of conversion remain controversial. MCI is now the focus of natural history studies, along with Alzheimer's disease (AD) prevention. The objective of our review will be to consider the question of whether MCI is a well enough established entity that it can be a diagnosis in medical practice and a valid target of Alzheimer's prevention therapy. MCI was originally defined by Petersen et al. (1999) as progressive memory loss, prodrome of Alzheimer's disease. More recently MCI has been expanded to other cognitive domains with other potential causes like normal aging, fronto-temporal dementia, and vascular dementia. Despite many consensus conferences, experts cannot agree on critical aspects of the MCI, particularly with respect to its clinical utility. Based on neuropsychological studies, a hippocampal memory profile has been proposed for MCI as prodromal AD. Further research is needed to advance these criteria. We have no doubt, however, that in the future, the diagnosis of AD as disease (not only a dementia syndrome) will be made in the early pre-dementia stage and will be drawn from a combination of neuropsychological, neuro-imaging and CSF biomarkers.

[Prevalence of mild cognitive impairment, amnestic-type, in a Colombian population]. / Prevalencia de deterioro cognitivo leve de tipo amnésico en una población colombiana.

INTRODUCTION: Mild cognitive impairment (MCI) is a clinical syndrome that presents with memory disorders, normal general cognition, and no compromise of activities of daily living or dementia. Its diagnosis has important clinical implications, since it behaves as a possible predictor of cognitive disorders that would suggest the onset of dementia. Amnestic-type MCI is considered to be a stage prior to Alzheimer-type dementia. The prevalence of MCI varies from 1-29% and the existence of this diagnosis implies a risk of presenting dementia at 12% per year. AIM: To establish the prevalence of amnestic-type MCI in a group of persons over the age of 50 years from the Valle de Aburra. PATIENTS AND METHODS: The sample was made up of 848 participants of both genders, over 50 years old, who lived in the metropolitan area of Medellin and had different socioeconomic and educational levels. Amnestic MCI was diagnosed according to the criteria proposed by the American Academy of Neurology. RESULTS: Prevalence of amnestic MCI was 9.7%, and was more predominant in males (p = 0.01) than in females. The prevalence was significantly lower in the group with more than 12 years of schooling (p < 0.05), and no significant differences in the prevalence were found in relation to age or economic status. CONCLUSION: The prevalence of amnestic MCI, 9.7%, found in our study is within the range reported by other researchers.

The influence of gestational age on severity of impairment in spastic cerebral palsy.

OBJECTIVE: To investigate the association between severity of impairment and gestational age in unilateral and bilateral spastic cerebral palsy, and to determine whether the influence of gestational age is independent of deviations from optimal birth weight. STUDY DESIGN: The study group was a United Kingdom cohort of 4772 cases of spastic cerebral palsy born between 1960 and 1997, with information on birth demographics and severity of impairment. Generalized additive models were used to determine the proportions of cases severely impaired, by gestational age, and to determine whether gestational age or deviations from optimal birth weight better predicts severity of impairment. RESULTS: For unilateral spastic cerebral palsy, the proportions of severe impairments did not vary with gestational age. In contrast, for bilateral spastic cerebral palsy, the proportions of severe motor or cognitive impairments increased with increasing gestational age (e.g., from 20% to 50% between weeks 30 and 40 for cognitive impairment). For spastic cerebral palsy, gestational age is at least as good as deviation from optimal birth weight in predicting severity. CONCLUSIONS: The severity of impairment increases with increasing gestational age in bilateral spastic cerebral palsy. This suggests differing etiologies in term and preterm infants and supports the theory that the developing brain is better able to compensate after a cerebral insult.

Accelerated forgetting in subjects with memory complaints. A new form of Mild Cognitive Impairment?

A study was carried out to investigate accelerated forgetting of new verbal and visual material in participants complaining of memory loss, individuals with Mild Cognitive Impairment(MCI) and controls. All groups were evaluated with a standard neuropsychological battery and two tests of delayed recall 6 weeks apart for the experimental tasks.Individuals with memory complaints,but not MCI, performed normally compared to controls on immediate and 30 minute recall,but showed a striking impairment in verbal and visual memory after 6 weeks. Accelerated forgetting may go undetected on standard neuropsychological evaluation in some patients complaining of memory problems.

Volumetric MRI measurements can differentiate Alzheimer's disease, mild cognitive impairment, and normal aging.

BACKGROUND: Volumetric magnetic resonance imaging (MRI) has been extensively studied in the last decade as a method to help with the clinical diagnosis of Alzheimer's disease (AD). In recent years, researchers have also started investigating if that technique would be useful to identify individuals with mild cognitive impairment (MCI), differentiating them from AD patients and from normal elderly controls. This research project was planned to assess the accuracy of volumetric MRI to differentiate those groups of individuals. METHOD: The investigation involved 39 patients with diagnosis of mild to moderate dementia in AD, according to the criteria of the NINCDS-ADRDA, DSM-III-R, and ICD-10; 21 subjects with complaints of cognitive decline without other psychiatric disorders (MCI); and 20 normal elderly controls. All the subjects were submitted to a standard protocol, including volumetric MRI evaluations. RESULTS: The results indicated that all regions of interest measured (amygdala, hippocampus, and parahippocampal gyrus) were significantly different (p < .005) in AD patients compared to MCI subjects and controls. The left volumetric measures (amygdala, hippocampus, and parahippocampal gyrus) were also significantly different between the MCI subjects and controls (p < .05). The discriminant function analysis correctly classified 88.14% of the AD patients and controls, 81.67% of AD patients and MCI subjects, and 80.49% of the MCI subjects and controls. CONCLUSIONS: The results suggest that measures of medial temporal lobe regions are useful to identify mild to moderate AD patients and MCI subjects, separating them from normal elderly individuals.

Time perception as a complex functional system: neuropsychological approach.

Ninety-two brain-damaged patients and 111 normal control subjects were tested on their orientation to date; sequencing of events; discrimination of simultaneity and succession; conditioning to time; comparison, production and reproduction of durations; conservation of velocity in clocks; construction of time units; and psychological time. Temporal disorientation was related to advanced age, low educational level, amnesia, dementia and limbic or diffuse brain lesions. Only multifocal-diffuse lesions accompanied by dementia could disintegrate the concept of metric time, while sparing psychological time, discrimination of durations and sequencing of canonically recurring events. Reproduction of durations and verbally mediated temporal conditioning were impaired in frontal and temporal-limbic lesions, which left intact the concept of time. The results support the hypothesis that temporal perception is accomplished by a complex functional system, regarding both its psychological structure and cerebral organization.

Rastreo cognitivo en pacientes con enfermedad de Chagas en estado crónico: estudio preliminar / Cognitive screening in chronic Chagasdisease: preliminary report

Un estudio piloto sobre el estado de las funciones cerebrales superiores fue llevado a cabo en 20 pacientes adultos con enfermedad de Chagas crónica. Sus resultados fueron comparados con un grupo control integrado por 10 sujetos normales agrupados por sexo y edad. Se empleó la bateria de pruebas neuropsicológicas de Luria. Los rendimientos de los pacientes chagásicos fueron en general inferiores a los de los controles, presentando diferencias estadísticamente significativas en las pruebas de memoria, definiciones(vocabulario), relaciones lógicas y analogías. De éstas, solo una definición, no estuvo contaminada por el nivel de educación. Los resultados sugieren que la enfermedad de Chagas, en su estadio crónico, puede ser responsable de la baja performance vista en algunas de las pruebas cognitivas. Sin embargo, es necesario efectuar estudios más extensos observando con mayor cuidado la selección de los pacientes y el nivel de educación antes de aceptar definitivamente esta presunción

Rastreo cognitivo en pacientes con enfermedad de Chagas en estado crónico: estudio preliminar / Cognitive screening in chronic Chagas'disease: preliminary report

Un estudio piloto sobre el estado de las funciones cerebrales superiores fue llevado a cabo en 20 pacientes adultos con enfermedad de Chagas crónica. Sus resultados fueron comparados con un grupo control integrado por 10 sujetos normales agrupados por sexo y edad. Se empleó la bateria de pruebas neuropsicológicas de Luria. Los rendimientos de los pacientes chagásicos fueron en general inferiores a los de los controles, presentando diferencias estadísticamente significativas en las pruebas de memoria, definiciones(vocabulario), relaciones lógicas y analogías. De éstas, solo una definición, no estuvo contaminada por el nivel de educación. Los resultados sugieren que la enfermedad de Chagas, en su estadio crónico, puede ser responsable de la baja performance vista en algunas de las pruebas cognitivas. Sin embargo, es necesario efectuar estudios más extensos observando con mayor cuidado la selección de los pacientes y el nivel de educación antes de aceptar definitivamente esta presunción

A comparison of efficacy of the key informant and community survey methods in the identification of childhood disability in Jamaica.

A comparison of the efficacy of the key informant and the community survey methods for identifying children with disability was carried out in the Jamaican component of an international epidemiological study of childhood disability. Approximately 130 key informants were exposed to a 2-day workshop giving information on signs of disability, aspects of the project, and available services. Questionnaires were given to enable the informants to refer children and they were reminded 6 months later. In the survey method, eight community workers completed a house-to-house survey of all families and administered the 10-question screen with probes on 5475 children, 2 to 9 years old. Seventeen referrals were made by the key informants; of these, two were found to have disabilities. Of the 821 children who tested positive on the 10-question screen in the house-to-house survey, 193 had disabilities. We concluded that the key informant method would not be a satisfactory way of identifying cases of childhood disability.