Comparison of digital games as a cognitive function assessment tool for current standardized neuropsychological tests.

OBJECTIVE: Cognitive dysfunction may occur postoperatively. Fast and efficient assessment of Postoperative Cognitive Dysfunction (POCD) can minimize loss of quality of life, and therefore, a study comparing a digital game with standard neuropsychological tests to assess executive, mnemonic, and attention functions to evaluate POCD seems to be relevant both for research and clinical practice. METHODS: A battery of standardized tests and a digital game (MentalPlus®) were administered to 60 patients at the Central Institute of Hospital das Clínicas in São Paulo (36 women and 24 men), with ages between 29 and 82 years, pre- and post-surgery performed under anesthesia. Correlation and linear regression model were used to compare the scores obtained from the standardized tests to the scores of the six executive and cognitive functions evaluated by the game (short- and long-term memory, selective and alternating attention, inhibitory control, and visual perception). RESULTS: After correlation analysis, a statistically significant result was found mainly for the correlation between the scores from the phase of the digital game assessing the visuoperception function and the scores from the A and B cards of the Stroop Test (p < 0.001, r = 0.99 and r = 0.64, respectively), and the scores from TMTA (p = 0.0046, r = 0.51). We also found a moderate correlation between the phase of the game assessing short-memory function and VVLT (p < 0.001, r = 0.41). No statistically significant correlations were found for the other functions assessed. CONCLUSION: The digital game provided scores in agreement with standardized tests for evaluating visual perception and possibly short-term memory cognitive functions. Further studies are necessary to verify the correlation of other phases of the digital game with standardized tests assessing cognitive functions.

Assessment of a digital game as a neuropsychological test for postoperative cognitive dysfunction.

OBJECTIVE: Postoperative cognitive dysfunction may result from worsening in a condition of previous impairment. It causes greater difficulty in recovery, longer hospital stays, and consequent delay in returning to work activities. Digital games have a potential neuromodulatory and rehabilitation effect. In this study, a digital game was used as a neuropsychological test to assess postoperative cognitive dysfunction, with preoperative patient performance as control. METHODS: It was a non-controlled study, with patients selected among candidates for elective non-cardiac surgery, evaluated in the pre- and postoperative periods. The digital game used has six phases developed to evaluate selective attention, alternating attention, visuoperception, inhibitory control, short-term memory, and long-term memory. The digital game takes about 25 minutes. Scores are the sum of correct answers in each cognitive domain. Statistical analysis compared these cognitive functions pre- and post-surgery using a generalized linear mixed model (ANCOVA). RESULTS: Sixty patients were evaluated, 40% male and 60% female, with a mean age of 52.7 ± 13.5 years. Except for visuoperception, a reduction in post-surgery scores was found in all phases of the digital game. CONCLUSION: The digital game was able to detect decline in several cognitive functions postoperatively. As its completion is faster than in conventional tests on paper, this digital game may be a potentially recommended tool for assessing patients, especially the elderly and in the early postoperative period.

The MentalPlus® Digital Game Might Be an Accessible Open Source Tool to Evaluate Cognitive Dysfunction in Heart Failure with Preserved Ejection Fraction in Hypertensive Patients: A Pilot Exploratory Study.

INTRODUCTION: Cognitive dysfunction with heart failure with reduced ejection fraction (HFrEF) is well studied. However, there are few comparative studies with heart failure and preserved ejection fraction (HFpEF). Cognitive dysfunction diagnosis usually demands a long neuropsychological battery. We developed MentalPlus® digital game to overwhelm that issue. METHODS: As a pilot study, we evaluated 60 patients with systemic hypertension and HFpEF. They were submitted to TICS (Telephone Interview Cognitive Status) to evaluate the general cognitive function and 25 minutes of MentalPlus® digital game evaluation. RESULTS: The results disclosed 60 hypertensive patients. All of them presented with HFpEF. Patients presented a mean age of 56±10 years; 46% male; LVMi (g/m2) mean of 110±20; educational attainment of 9 years or more; mean income of 8 Brazilian minimum wages. The TICS results disclosed 28 ±3.7. MentalPlus® digital game evaluation disclosed preserved values for the phases I, III, IV, V, VI, and VII. Phase II, short-term memory related, was below the normals values that were assigned. This group of patients presented a normal general cognition by both evaluations, except for specific functions displayed above, disclosed by MentalPlus®. The MentalPlus® was designed to possibly evaluate specific cognitive functions separately, like attention, memory, executive function, and language, because each phase evaluates specific functions shortly. CONCLUSION: Hypertensive HFpEF patients presented in general a normal cognition, except for some aspects related to short-term memory. The MentalPlus® digital game, compared with TICS, presented similar general results. It is an advantage that MentalPlus® software could be used to assess cognitive function, in general and individually, and be an open tool shortly.

Transcranial Direct Current Stimulation Effects on Athletes' Cognitive Performance: An Exploratory Proof of Concept Trial.

Among the 2016 Olympic and Paralympic Games' unforgettable moments, one could not overlook performances by Phelps and Bolt, which challenge old premises about the maximum extension of individual supremacism in ultracompetitive modalities and the doping scandals. Different media channels resonated these two trends, with an unseen rise on discussions about traits and practices that may set ultrahigh performance athletes apart from the more ordinary ones. Yet, some key issues remain undebated. This paper aims to add to this debate, with a proof of concept trial, which investigates whether transcranial direct current stimulation (tDCS) may serve as an aid for professional athletes. Ten professional athletes of three different modalities (judo, N = 4 athletes, swimming, N = 3 athletes, and rhythmic gymnastics, N = 3 athletes) received anodal stimulation (2 mA) for 20 min on the left dorsolateral prefrontal cortex for ten consecutive weekdays. We observed a positive effect of tDCS in their cognitive performance, including a significant improvement in alternated, sustained, and divided attention and in memory scores. We also observed a decrease in Beck Depression Inventory scores (4.50 points) in this non-clinical population. These preliminary results suggest that tDCS sessions may translate into competitive advantages for professional athletes and recommend the deepening of the discussion on its ethical use in sports, which is ultimately tied to the wider debate around the risks and opportunities that neuromodulation brings to the table.

Effects of Single Low Dose of Dexamethasone before Noncardiac and Nonneurologic Surgery and General Anesthesia on Postoperative Cognitive Dysfunction-A Phase III Double Blind, Randomized Clinical Trial.

UNLABELLED: Postoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients. This study evaluated the effect of dexamethasone on POCD incidence after noncardiac and nonneurologic surgery. METHODS: One hundred and forty patients (ASA I-II; age 60-87 years) took part in a prospective phase III, double blind, randomized study involving the administration or not of 8 mg of IV dexamethasone before general anesthesia under bispectral index (BIS) between 35-45 or 46-55. Neuropsychological tests were applied preoperatively and on the 3rd, 7th, 21st, 90th and 180th days after surgery and compared with normative data. S100ß was evaluated before and 12 hours after induction of anesthesia. The generalized estimating equations (GEE) method was applied, followed by the posthoc Bonferroni test considering P<0.05 as significant. RESULTS: On the 3rd postoperative day, POCD was diagnosed in 25.2% and 15.3% of patients receiving dexamethasone, BIS 35-45, and BIS 46-55 groups, respectively. Meanwhile, POCD was present in 68.2% and 27.2% of patients without dexamethasone, BIS 35-45 and BIS 46-55 groups (p<0.0001). Neuropsychological tests showed that dexamethasone associated to BIS 46-55 decreased the incidence of POCD, especially memory and executive function. The administration of dexamethasone might have prevented the postoperative increase in S100ß serum levels. CONCLUSION: Dexamethasone can reduce the incidence of POCD in elderly patients undergoing surgery, especially when associated with BIS 46-55. The effect of dexamethasone on S100ß might be related with some degree of neuroprotection. TRIAL REGISTRATION: www.clinicaltrials.gov NCT01332812.

Definition and application of neuropsychological test battery to evaluate postoperative cognitive dysfunction.

OBJECTIVE: To investigate the adequacy of the neuropsychological test battery proposed by the International Study of Postoperative Cognitive Dysfunction to evaluate this disorder in Brazilian elderly patients undergoing surgery under general anesthesia. METHODS: A neuropsychological assessment was made in patients undergoing non-cardiac surgery under general anesthesia, aged over 65 years, literate, with no history of psychiatric or neurological problems and score on the Mini Mental State Examination at or above the cutoff point for the Brazilian population (>18 or >23) according to the schooling level of the subject. Eighty patients were evaluated by a trained team of neuropsychologists up to 24 hours before elective surgery. RESULTS: Among the patients evaluated, one was excluded due to score below the cutoff point in the Mini Mental State Examination and two did not complete the test battery, thus remaining 77 patients in the study. The mean age was 69±7.5 years, and 62.34% of the subjects had ±4 years of study. The subjects had significantly lower averages than expected (p<0.001) for normative tables on neuropsychological tests. CONCLUSION: The study demonstrated the applicability of the instruments in the Brazilian elderly and low schooling level population, but suggested the need to determine cutoff points appropriate for these individuals, ensuring the correct interpretation of results. This battery is relevant to postoperative follow-up evaluations, favoring the diagnosis of postoperative cognitive dysfunction in patients undergoing different types of surgery and anesthetic techniques.

Definition and application of neuropsychological test battery to evaluate postoperative cognitive dysfunction / Definição e aplicação de bateria de testes neuropsicológicos para avaliação de disfunção cognitiva pós-operatória

Objective To investigate the adequacy of the neuropsychological test battery proposed by the International Study of Postoperative Cognitive Dysfunction to evaluate this disorder in Brazilian elderly patients undergoing surgery under general anesthesia. Methods A neuropsychological assessment was made in patients undergoing non-cardiac surgery under general anesthesia, aged over 65 years, literate, with no history of psychiatric or neurological problems and score on the Mini Mental State Examination at or above the cutoff point for the Brazilian population (>18 or >23) according to the schooling level of the subject. Eighty patients were evaluated by a trained team of neuropsychologists up to 24 hours before elective surgery. Results Among the patients evaluated, one was excluded due to score below the cutoff point in the Mini Mental State Examination and two did not complete the test battery, thus remaining 77 patients in the study. The mean age was 69±7.5 years, and 62.34% of the subjects had ±4 years of study. The subjects had significantly lower averages than expected (p<0.001) for normative tables on neuropsychological tests. Conclusion The study demonstrated the applicability of the instruments in the Brazilian elderly and low schooling level population, but suggested the need to determine cutoff points appropriate for these individuals, ensuring the correct interpretation of results. This battery is relevant to postoperative follow-up evaluations, favoring the diagnosis of postoperative cognitive dysfunction in patients undergoing different types of surgery and anesthetic techniques. .

Objetivo Investigar a adequação da bateria neuropsicológica proposta pelo International Study of Postoperative Cognitive Dysfunction para a avaliação de disfunção cognitiva pós-operatória em pacientes idosos brasileiros submetidos à cirurgia sob anestesia geral. Métodos Foi realizada uma avaliação neuropsicológica em pacientes submetidos a cirurgias não cardíacas sob anestesia geral, com idade >65 anos, alfabetizados, sem histórico de problemas psiquiátricos ou neurológicos e com pontuação no Miniexame do Estado Mental igual ou superior ao ponto de corte para a população brasileira (>18 ou >23) de acordo com a escolaridade do sujeito. Oitenta pacientes foram avaliados por equipe treinada de neuropsicólogos até 24 horas antes da cirurgia de caráter eletivo. Resultados Dentre os pacientes avaliados, um foi excluído por apresentar pontuação abaixo do ponto de corte no Miniexame do Estado Mental e dois não completaram a bateria de testes, permanecendo 77 pacientes no estudo. A média de idade foi de 69±7,5 anos, com 62,34% dos sujeitos, com ±4 anos de estudo. Os sujeitos apresentaram médias significativamente inferiores ao esperado (p<0,001) para tabelas normativas nos testes neuropsicológicos. Conclusão O estudo demonstrou a aplicabilidade dos instrumentos na população brasileira idosa e de baixa escolaridade, mas sugeriu a necessidade de determinação de pontos de corte adequados a essa população, garantindo a correta interpretação de resultados. Tal bateria é relevante para avaliações de seguimento pós-cirúrgico, favorecendo o diagnóstico de disfunção cognitiva pós-operatória em pacientes submetidos a diferentes tipos de cirurgia e técnicas anestésicas. .

Avaliação dos efeitos da dexametasona sobre a incidência de disfunção cognitiva pós-operatória em idosos submetidos à anestesia geral / Evaluation of the effects of dexamethasone on the incidence of postoperative cognitive dysfunction in elderly patients undergoing general anesthesia

Introdução: Disfunção cognitiva pós-operatória (POCD) é um evento adverso multifatorial mais frequente em pessoas com idade superior a 60 anos ou doenças neurológicas e psiquiátricas. Este estudo avaliou o efeito da dexametasona sobre a incidência de POCD em idosos após cirurgia não cardíaca sob anestesia geral. Métodos: Cento e quarenta pacientes (ASA I-II, idade 60-87 anos) participaram deste estudo prospectivo, randomizado, envolvendo a administração ou não de 8 mg de dexametasona IV antes da indução anestésica para anestesia geral profunda ou superficial de acordo com o índice bispectral. Os testes neuropsicológicos foram aplicados no pré-operatório e em 3, 7, 21, 90 e 180 dias após a cirurgia e comparados com os dados normativos. Enolase específica do neurônio e S100beta foram avaliados antes e 12 horas após a indução da anestesia. A regressão linear com inferência baseada no método de equações de estimação generalizadas (GEE) foi aplicado, seguido pelo teste post-hoc de Bonferroni, considerando P <0,05 como significativo. Resultados: No terceiro dia pós-operatório, POCD foi diagnosticada em 25,2% dos pacientes que receberam a dose de dexametasona e anestesia profunda, 15,3% nos pacientes que receberam a dose da dexametasona e anestesia superficial, 68,2% do grupo de anestesia profunda e 27,2% do grupo de anestesia superficial (p < 0,0001). Os testes neuropsicológicos demonstraram que a anestesia superficial e a dose de dexametasona antes da indução anestésica diminuiu a incidência de POCD, especialmente para as funções memória e atenção e para a função executiva. A administração de dexametasona preveniu o aumento nos níveis séricos de S100beta no pós-operatório (p < 0,002) bem como está relacionado com uma diminuição significativa nos níveis séricos de enolase específica de neurônio (NSE) (p < 0,001). A memória imediata apresentou diferença entre pacientes com e sem alelo APOe4 (p = 0,025) independente do momento de avaliação. A memória de longo prazo...

Background: Postoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients or people aged over 60 years, neurological and psychiatric diseases. This study evaluated the effect of dexamethasone on POCD incidence after non-cardiac surgery and general anesthesia. Methods: One hundred and forty patients (ASA I-II; age 60-87 years) took part in a prospective randomized study involving the administration or not of 8 mg of IV dexamethasone before deep or superficial anesthesia according to bispectral index. Neuropsychological tests were applied preoperatively and at 3rd, 7th, 21st, 90th and 180th days after surgery and compared with normative data. Neuron specific enolase and S100beta were evaluated before and 12 hours after induction of anesthesia. Linear regression with inference based on the generalized estimating equations (GEE) method was applied, followed by the post-hoc Bonferroni test considering P < 0.05 as significant. Results: On the 3rd postoperative day, POCD was diagnosed in 25.2% of patients receiving dexamethasone plus deep anesthesia, 15.3% of the dexamethasone plus superficial anesthesia group, 68.2% of the deep anesthesia group and 27.2% of the superficial anesthesia group (p < 0.0001). Neuropsychological tests showed that dexamethasone plus superficial anesthesia decreased the incidence of POCD, especially memory, attention and executive function. The administration of dexamethasone prevented the postoperative increase in S100? serum levels (p < 0.002) and it is also related with a significant decrease in serum levels of neuron specific enolase (p < 0.001). Immediate memory was different between patients with and without APOe4 allele (p = 0.025) independent of the moment of assessment. The Long-term memory was impaired over the evaluation periods in patients with and without the presence of APOe4 allele (p = 0.006 and p = 0.017 respectively). Patients with the APOe4 allele had higher...