Euphoric Presentation in Creutzfeldt-Jakob Disease and Its Diagnostic Implications: A Case Report.

Creutzfeldt-Jakob disease (CJD) constitutes an aggressively advancing, terminal neurodegenerative condition classified within the spectrum of transmissible spongiform encephalopathies. The difficulty in establishing a diagnosis before death arises from the condition's rarity and the resulting limited level of suspicion attributed to it. The polymorphic nature of CJD symptoms contributes to the challenge of early diagnostic recognition. Emotional and behavioral changes have been well documented, but the initial presentation of euphoria has not been documented. Here, we present the case of a female patient who was experiencing an unusual state of euphoria followed by intermittently altered mental status. She was ultimately diagnosed with sporadic CJD, discharged home on hospice, and died within six months of discharge.

Functional and structural brain MRI changes associated with cognitive worsening in multiple sclerosis: a 3-year longitudinal study.

BACKGROUND: Heterogeneous processes may contribute to cognitive impairment in multiple sclerosis (MS). OBJECTIVE: To apply a longitudinal multiparametric MRI approach to identify mechanisms associated with cognitive worsening in MS patients. METHODS: 3 T brain functional and structural MRI scans were acquired at baseline and after a median follow-up of 3.4 years in 35 MS patients and 22 healthy controls (HC). Associations between cognitive worsening (reliable change index score < - 1.25 at the Rao's battery) and longitudinal changes in regional T2-hyperintense white matter (WM) lesions, diffusion tensor microstructural WM damage, gray matter (GM) atrophy and resting state (RS) functional connectivity (FC) were explored. RESULTS: At follow-up, HC showed no clusters of significant microstructural WM damage progression, GM atrophy or changes in RS FC. At follow-up, 10 MS patients (29%) showed cognitive worsening. Compared to cognitively stable, cognitively worsened MS patients showed more severe GM atrophy of the right anterior cingulate cortex and bilateral supplementary motor area (p < 0.001). Cognitively worsened vs cognitively stable MS patients showed also decreased RS FC in the right hippocampus of the right working memory network and in the right insula of the default mode network. Increased RS FC in the left insula of the executive control network was found in the opposite comparison (p < 0.001). No significant regional accumulation of focal WM lesions nor microstructural WM abnormalities occurred in both patients' groups. CONCLUSIONS: GM atrophy progression in cognitively relevant brain regions combined with functional impoverishment in networks involved in cognitive functions may represent the substrates underlying cognitive worsening in MS.

Chronic consumption of a hypercaloric diet increases neuroinflammation and brain senescence, promoting cognitive decline in middle-aged female Wistar rats.

Being overweight and obesity are world health problems, with a higher prevalence in women, defined as abnormal or excessive fat accumulation that increases the risk of chronic diseases. Excess energy leads to adipose expansion, generating hypertrophic adipocytes that produce various pro-inflammatory molecules. These molecules cause chronic low-intensity inflammation, affecting the organism's functioning and the central nervous system (CNS), inducing neuroinflammation. The neuroinflammatory response during obesity occurs in different structures of the CNS involved in memory and learning, such as the cortex and the hippocampus. Here we analyzed how obesity-related peripheral inflammation can affect CNS physiology, generating neuroinflammation and promoting cellular senescence establishment. Since some studies have shown an increase in senescent cells during aging, obesity, and neurodegenerative diseases, we proposed that cellular senescence participation may contribute to the cognitive decline in an obesity model of middle-aged female Wistar rats. The inflammatory state of 6 and 13 months-old female Wistar rats fed with a hypercaloric diet was measured in serum and CNS (cortex and hippocampus). Memory was evaluated using the novel object recognition (NOR) test; the presence of senescent markers was also determined. Our data suggest that the systemic inflammation generated by obesity induces a neuroinflammatory state in regions involved in learning and memory, with an increase in senescent markers, thus proposing senescence as a potential participant in the negative consequences of obesity in cognition.

Estandarización de la batería de Evaluación de la Memoria Semántica (EMSEA) en adultos mayores institucionalizados de Lima / Standardization of the Semantic Memory Evaluation Battery (EMSEA) in institutionalized elderly adults of Lima

Objetivo: Determinar si la memoria semántica es un factor asociado al deterioro cognitivo en adultos mayores de Lima. Método: Se aplicaron la batería de Evaluación de la Memoria Semántica para Adultos Mayores (EMSEA), el Mini-mental State Examination (MMSE) y otros instrumentos que fueron utilizados como criterios externos. La muestra estuvo constituida por 158 adultos mayores de Lima Metropolitana entre 60 a 95 años de edad. La EMSEA diferencia entre una muestra normal y clínica, siendo la sensibilidad de 80% y la especificidad de 100% para un punto de corte de 251. Se evidencia validez concurrente y se demuestra un modelo EMSEA de dos factores. La confiabilidad fue adecuada con valor Alfa de Cronbach de .75 y Theta de .80. Resultados: Los datos descriptivos señalaron un 28% de prevalencia de deterioro cognitivo y 23% de nivel de memoria semántica bajo. El modelo predictivo señala que tres áreas de la memoria semántica están asociadas al deterioro cognitivo con un R2 de 25%, quedando el modelo establecido por: Verificación, denominación de dibujos y analogías. Conclusión: Se concluye que la batería EMSEA presenta evidencia de validez de criterio y constructo, así como consistencia interna. (AU)

Objective: To determine if semantic memory is a factor associated with cognitive impairment in older adults in Lima. Method: The Semantic Memory Assessment Battery for Older Adults (EMSEA), the Mini-mental State Examination (MMSE) and other instruments that were used as external criteria were applied. The sample consisted of 158 older adults from Metropolitan Lima between 60 and 95 years of age. EMSEA differentiates between a normal and clinical sample, with a sensitivity of 80% and a specificity of 100% for a cut-off point of 251. Concurrent validity is evidenced and a two-factor EMSEA model is demonstrated. Cronbach's Alpha value is .75 and Theta is .80. Results: Descriptive data indicated a 28% prevalence of cognitive impairment and a 23% low semantic memory level. The predictive model indicates that three areas of semantic memory are associated with cognitive impairment with an R2 of 25%, leaving the model established by: Verification, naming of drawings and analogies. Conclusion: It is concluded that the EMSEA battery presents evidence of criterion and construct validity, internal consistency and a predictive. (AU)

Working memory deterioration as an early warning sign for relapse in remitted psychosis: A one-year naturalistic follow-up study.

BACKGROUND: Relapse prevention is an important goal in the clinical management of psychosis. Cognitive deficits/deterioration can provide useful insights for monitoring relapse in psychosis patients. METHODS: This was a prospective, naturalistic 1-year follow-up study involving 110 psychosis patients with full clinical remission. Relapse, defined as the recurrence of psychotic symptoms, was monitored monthly along with digital tracking of verbal and visual working memory using a mobile app developed for this study. Cognitive deterioration was defined as worsening performance over 2 months prior to relapse or study termination, whichever was earlier. Other clinical, cognitive, functioning, and psychosocial variables were also collected. RESULTS: At 1 year, 18 (16.36%) patients relapsed, of which 6 (33.33%) required hospitalization. Relapse was predicted by verbal working memory deterioration 2 months prior to relapse (p = 0.029), worse medication adherence (p = 0.018), and less resilience (p = 0.014). CONCLUSIONS: Verbal working memory deterioration is a novel early sign of relapse. It is a clearly defined, objectively measurable, and reproducible marker that can help clinicians and healthcare workers identify patients at risk of relapse and make decisions about maintenance therapy. Moreover, digital monitoring is a viable tool in the management of relapse.

Neuropsychiatric symptoms in patients with possible vascular cognitive impairment, does sex matter?

Background: Neuropsychiatric symptoms (NPS) are common in patients with vascular cognitive impairment (VCI). We aimed to establish sex differences in the manifestation of NPS in memory clinic patients with possible VCI and identify which NPS are determinants of clinical progression in women and men separately. Methods: We included 718 memory clinic patients (age 68 ± 8; 45% women) with cognitive complaints and vascular brain lesions on MRI (i.e. possible VCI). NPS were measured using the 12-item Neuropsychiatric Inventory. Clinical progression after two years (women 18%, men 14%) was defined as increase in CDR ≥1 or institutionalization (available n = 589 without advanced dementia at baseline). The association between NPS and clinical progression was assessed with Cox proportional hazard models stratified by sex, adjusted for age and clinical diagnosis and in a second model additionally for manifestations of vascular brain lesions. Results: Men more often presented with agitation (29% versus 17%, p<.05) and irritability (58% versus 45%, p<.05), the other 10 NPS (delusions, hallucinations, depression, anxiety, euphoria, apathy, disinhibition, aberrant motor behavior, nighttime disturbances and appetite & eating abnormalities) did not differ between sexes. In women the presence of apathy (HR 2.1[1.1;4.3]) was associated with higher risk of clinical progression. In men the presence of depression (HR 2.7[1.4;5.1]) and aberrant motor behavior (HR 2.1[1.1;3.8]) were associated with increased risk of clinical progression. Conclusion: Manifestations of NPS in patients with possible VCI differ by sex. Different NPS are associated with future clinical progression in men and women. Management strategies of NPS could benefit from sex-specific approaches.

Apomorfina y disfunción frontal en la enfermedad de Parkinson / Apomorphine and frontal dysfunction in Parkinson’s disease

Introducción: El trastorno disejecutivo y la apatía son síntomas característicos de la disfunción frontal ligada a la enfermedad de Parkinson. El efecto de la infusión continua subcutánea de apomorfina en la disfunción frontal no se conoce con detalle. Desarrollo: Se ha realizado una búsqueda y análisis de los trabajos publicados más relevantes en este campo. La apomorfina logra mejorías en las pruebas que miden tareas como la planificación, la atención, la fluencia verbal y la apatía. Conclusiones: Debido a su perfil farmacológico distintivo, con mayor actividad sobre los receptores dopaminérgicos de tipo D1, la apomorfina puede resultar beneficiosa en la disfunción frontal de la enfermedad.(AU)

Introduction: Dysexecutive disorder and apathy are characteristic symptoms of frontal dysfunction linked to Parkinson’s disease. The effect of continuous subcutaneous apomorphine infusion is not known in detail. Development: A search for the most relevant studies published to date in this field was carried out, along with their analysis. Apomorphine achieves improvements in tests that measure tasks such as planning, attention, verbal fluency and apathy. Conclusions: Due to its distinctive pharmacological profile, with enhanced activity on D1-type dopaminergic receptors, apomorphine may have beneficial effects on the frontal dysfunction produced by the diseas.(AU)

Neuropsychiatric Symptoms as Predictor of Poor Clinical Outcome in Patients With Vascular Cognitive Impairment.

OBJECTIVE: Examine the association between neuropsychiatric symptoms (NPS) and clinical outcome in memory clinic patients with vascular brain injury. DESIGN/SETTING: TRACE-VCI prospective memory clinic cohort with follow-up (2.1 ± 0.5 years). PARTICIPANTS: Five hundred and seventy-five memory clinic patients with vascular brain injury on MRI (i.e. possible Vascular Cognitive Impairment [VCI]). Severity of cognitive impairment ranged from no objective cognitive impairment to mild cognitive impairment (MCI) and dementia. MEASUREMENTS: We used Neuropsychiatric Inventory (total score and score on hyperactive, psychotic, affective, and apathetic behavior domains) to measure NPS. We assessed the association between NPS and institutionalization, mortality and cognitive deterioration (increase ≥0.5 on Clinical Dementia Rating scale) with Cox proportional hazards models and logistic regression analyses. RESULTS: NPS were present in 89% of all patients, most commonly in the hyperactive and apathetic behavior domain. Across the whole cohort, affective behavior was associated with institutionalization (HR: 1.98 [1.01-3.87]), mainly driven by the dementia subgroup (HR: 2.06 [1.00-4.21]). Apathetic behavior was associated with mortality and cognitive deterioration (HR: 2.07 [1.10-3.90],OR: 1.67 [1.12-2.49], respectively), mainly driven by the MCI subgroup (HR: 4.93 [1.07-22.86],OR: 3.25 [1.46-7.24], respectively). Conversely, hyperactive behavior was related to lower mortality (HR: 0.54 [0.29-0.98]), again particularly driven by the MCI subgroup (HR:0.17 [0.04-0.75]). Psychotic behavior was associated with cognitive deterioration in patients with no objective cognitive impairment (OR: 3.10 [1.09-8.80]) and with institutionalization in MCI (HR: 12.45 [1.28-121.14]). CONCLUSION: NPS are common and have prognostic value in memory clinic patients with possible VCI. This prognostic value depends on the severity of cognitive impairment.

Connection between sleeping patterns and cognitive deterioration in women with Alzheimer's disease.

BACKGROUND: Alzheimer's disease (AD) causes symptoms such as dementia, memory loss, disorientation, and even aggressiveness, and is more common in women than in men. AD may also manifest itself in changes in sleep patterns. However, the relationship between AD (in all stages) and bedtime behavior has not been thoroughly investigated. METHODS: In a prospective, cross-sectional survey, we evaluated 74 women categorized in two different stages of cognitive decline associated with AD (mild and severe) along with 37 women with no cognitive decline who served as controls. We obtained demographic and medical information such as age, health status, and medication, as well as psychiatrically confirmed staging of AD. We also collected actigraphy data for several nights in a row with a medical grade wristband using a 3-axis accelerometer and solid-state on-board memory. These data served as parameters for a clustering machine learning (ML) algorithm. RESULTS: The ML process was able to unsupervisedly identify 85% of the participants according to their pre-assigned degree of dementia. When the clustering was carried out in a binary fashion (i.e., only taking into account healthy members vs. severely affected AD patients), it was possible to correctly classify 91% of the cases. CONCLUSIONS: This study revealed a strong connection between the severity of the intellectual decline and the features distilled from actigraphically derived sleep parameters.

Air Pollution Is Associated with Cognitive Deterioration of Alzheimer's Disease.

INTRODUCTION: Dementia is one of the major causes of disability and dependency among older people worldwide. Alz-heimer's disease (AD), the most common cause of dementia among the elderly, has great impact on the health-care system of developed nations. Several risk factors are suggestive of an increased risk of AD, including APOE-ε4, male, age, diabetes mellitus, hypertension, and low social engagement. However, data on risk factors of AD progression are limited. Air pollution is revealed to be associated with increasing dementia incidence, but the relationship between air pollution and clinical AD cognitive deterioration is unclear. METHODS: We conducted a case-control and city-to-city study to compare the progression of AD patients in different level of air-polluted cities. Clinical data of a total of 704 AD patients were retrospectively collected, 584 residences in Kaohsiung and 120 residences in Pingtung between 2002 and 2018. An annual interview was performed with each patient, and the Clinical Dementia Rating score (0 [normal] to 3 [severe stage]) was used to evaluate their cognitive deterioration. Air pollution data of Kaohsiung and Pingtung city for 2002-2018 were retrieved from Taiwan Environmental Protection Administration. Annual Pollutant Standards Index (PSI) and concentrations of particulate matter (PM10), sulfur dioxide (SO2), ozone (O3), nitrogen dioxide (NO2), and carbon monoxide (CO) were obtained. RESULTS: The PSI was higher in Kaohsiung and compared with Pingtung patients, Kaohsiung patients were exposed to higher average annual concentrations of CO, NO2, PM10, and SO2. AD patients living in Kaohsiung suffered from faster cognitive deterioration in comparison with Pingtung patients (log-rank test: p = 0.016). When using multivariate Cox proportional hazards regression analysis, higher levels of CO, NO2, PM10, and SO2 exposure were associated with increased risk of AD cognitive deterioration. Among all these air pollutants, high SO2 exposure has the greatest impact while O3 has a neutral effect on AD cognitive deterioration. CONCLUSIONS: Air pollution is an environment-related risk factor that can be controlled and is associated with cognitive deterioration of AD. This finding could contribute to the implementation of public intervention strategies of AD.

Apolipoprotein E ɛ4-related effects on cognition are limited to the Alzheimer's disease spectrum.

Whether the deleterious effects of APOE4 are restricted to the Alzheimer's disease (AD) spectrum or cause cognitive impairment irrespectively of the development of AD is still a matter of debate, and the focus of this study. Our analyses included APOE4 genotype, neuropsychological variables, amyloid-ßeta (Aß) and Tau markers, FDG-PET values, and hippocampal volumetry data derived from the healthy controls sample of the ADNI database. We formed 4 groups of equal size (n = 30) based on APOE4 carriage and amyloid-PET status. Baseline and follow-up (i.e., 48 months post-baseline) results indicated that Aß-positivity was the most important factor to explain poorer cognitive performance, while APOE4 only exerted a significant effect in Aß-positive subjects. Additionally, multiple regression analyses evidenced that, within the Aß-positive sample, hippocampal volumetry explained most of the variability in cognitive performance for APOE4 carriers. These findings represent a strong support for the so-called preclinical/prodromal hypothesis, which states that the reported differences in cognitive performance between healthy carriers and non-carriers are mainly due to the APOE4's capability to increase the risk of AD. Moreover, our results reinforce the notion that a synergistic interaction of Aß and APOE4 elicits a neurodegenerative process in the hippocampus that might be the main cause of impaired cognitive performance.

Using the MMSE-2 to Measure Cognitive Deterioration in a Sample of Psychiatric Patients Living in Puerto Rico.

Patients with psychiatric disorders often have cognitive impairment. Several deficits have been recognized in patients with mood and/or psychotic disorders. We hypothesized that differences in the levels of deterioration exist between patients with bipolar disorder (BD), major depressive disorder (MDD), and schizoaffective disorder (SAD). The mini-mental state examination, version 2 (MMSE-2), was used with a sample of 160 psychiatric patients to measure cognitive impairment. The aims of this studyssss were as follows: (1) To characterize the differences in cognitive deterioration among patients diagnosed with BD, MDD, or SAD; (2) to explore item difficulty and cutoff points based on the educational level and other variables which are significant for our psychiatric population. Descriptive statistics were used for categorical variables. In addition, a Bonferroni post hoc test and an analysis of covariance (ANCOVA) for the continuous dependent variable were performed. Psychiatric diagnosis and years of education adjusted by several covariates proved to be significant. The 25th percentile were obtained to establish the cutoff points. Each item's difficulty was analyzed using means and chi-square tests. Cognitive deterioration was found in 51% of the patients with SAD, in 31% with BD, and in 18% with MDD.

Medición de reserva cognitiva: estudio en una muestra de adultos chilenos / Cognitive reserve assessment: a study in a sample of chilean adults

Mayor reserva se asocia con resistencia al deterioro en sujetos con enfermedades neurodegenerativas. En personas sanas explica las diferencias interindividuales en el rendimiento de tareas. Medir los factores de reserva cognitiva permite contar con un índice numérico de la ganancia cognitiva acumulada por un sujeto. Este índice puede ser correlacionado con otras funciones cuantificables. El presente trabajo tiene como objetivo presentar los índices de reserva obtenidos por una población chilena en la aplicación del Cognitive Reserve Index Questionnaire (CRIq). Para ello 90 adultos (18-85 años) sin evidencias de trastorno cognitivo, de la región de Valparaíso-Chile, fueron entrevistados sobre actividades de estudio, laborales y de tiempo libre ejecutadas desde los 18 años.Los resultados muestran que los índices de reserva de los sujetos varían en función del tiempo de ejecución de actividades promotoras de reserva y no por su edad. Se encontraron diferencias estadísticamente significativas entre los grupos etarios. Estos resultados permiten concluir que la ejecución de actividades de estudio, laborales, sociales, entre otras aumenta los índices de reserva cognitiva, que es una variable diferenciadora entre individuos. La medición de dichos índices puede ser útil en un amplio campo de disciplinas (medicina, neurología, neuropsicología, educación, psicología, fonoaudiología, neurociencias y en las ciencias cognitivas en general).

A higher cognitive reserve is linked to higher resistance to deterioration among subjects suffering from neurodegenerative disorders. In healthy persons the cognitive reserve explains inter-individual differences in task performance. Measuring the cognitive reserve factors involves obtaining a numerical index of the cumulative cognitive gain accumulated by a subject. This index can be correlated with other measurable functions.This study was conceived to determine the reserve indexes accumulated by a Chilean sample, by means of the administration of the Cognitive Reserve Index Questionnaire (CRIq).In order to do so, 90 adults (18-85 years old) without evidence of cognitive disorder, living in Valparaíso region, Chile, were interviewed about their education, their work environment and their and leisure activities carried out since they were 18 years old.Results showed that reserve indexes of the subjects vary as a function of the time of execution of reserve-promoting activities, not age. Statistically significant differences were found among age-groups. These findings allow us to conclude that studying, working and engaging in social activities, among other things, increase the cognitive reserve indexes, which are a differentiating variable among individuals.The measurement of these indexes can be useful in a wide array of disciplines: medicine, neurology, neuropsychology, education, psychology, phonoaudiology, neurosciences and cognitive sciences in general.

Pharmacological Interventions to Attenuate Alzheimer's Disease Progression: The Story So Far.

Alzheimer's disease (AD) is a progressive neurodegenerative disease and the most common cause of dementia in the elderly. Up to date, the available pharmacological options for AD are limited to cholinesterase inhibitors and memantine that may only provide modest symptomatic management with no significance in slowing down the disease progression. Over the past three decades, the increased interest in and the understanding of AD major pathological hallmarks have provided an insight into the mechanisms mediating its pathogenesis, which in turn introduced a number of hypotheses and novel targets for the treatment of AD. Initially, targeting amyloid-beta and tau protein was considered the most promising therapeutic approach. However, further investigations have identified other major players, such as neuroinflammation, impaired insulin signalling and defective autophagy, that may contribute to the disease progression. While some promising drugs are currently being investigated in human studies, the majority of the previously developed medical agents have come to an end in clinical trials, as they have failed to illustrate any beneficial outcome. This review aims to discuss the different introduced approaches to alleviate AD progression; in addition, provides a comprehensive overview of the drugs in the development phase as well as their mode of action and an update of their status in clinical trials.

Caracterización de las condiciones de salud de los adultos mayores en Centros Geriátricos de la ciudad de Loja. Ecuador, 2017 / Characterization of the health conditions of the elderly in geriatric centers of the city of Loja. Ecuador, 2017

Introducción: Los cambios demográficos que ocurren a nivel mundial no son ajenos a Ecuador, donde la esperanza de vida de la población ha aumentado. Objetivo: Caracterizar las condiciones de salud de los adultos mayores que asistieron a centros geriátricos en la ciudad de Loja en el año 2017. Material y Métodos: Estudio descriptivo de corte transversal, donde se utilizaron técnicas cuantitativas, aplicándose diferentes escalas geriátricas a 87 adultos mayores que asistían al Centro Municipal de Atención al Adulto Mayor No.1 y a los centros Daniel Álvarez y San José, de la ciudad de Loja, Ecuador. Resultados: El 59.1% de los adultos mayores estudiados fueron mujeres, el 59,7 por ciento apenas tenían escolaridad básica o primaria, con un promedio de edad de 84,01 años. Se precisó que el 62,1 por ciento de ellos no presentaron comorbilidad. Fue identificado déficit neurosensorial visual (64,4 por ciento y auditivo (50,6 por ciento). Se constató fragilidad en el 54,0 por ciento de los casos e indicadores de dependencia funcional para las actividades básicas (73,5 por ciento) y para las actividades instrumentales (93.1 por ciento). El déficit cognitivo fue evaluado en el 50,6 por ciento y la depresión fue diagnosticada en el 56,3 por ciento de ellos. Conclusiones: Los adultos mayores estudiados fueron predominantemente mujeres, con escolaridad básica o primaria y con un promedio de edad superior a los 80 años. Prevalecieron los sujetos que tenían ausencia de comorbilidad, déficit visual y auditivo, fragilidad física, dependencia funcional para realizar las actividades básicas e instrumentales de la vida diaria, deterioro cognitivo y depresión(AU)

Introduction: The demographic changing on a worldwide scale are not unfamiliar to Ecuador where the life expectancy of the population has increased. Objective: To characterize the health conditions of the elderly who attended geriatric centers in the city of Loja in 2017. Material and Methods: Descriptive cross-sectional study where quantitative techniques were used applying different geriatric scales to 87 older adults who attended the Municipal Elderly Care Center No. 1, and Daniel Álvarez and San José Centers in the city of Loja, Ecuador. Results: The 59.1 percent of the older adults studied were women; 59.7 percent had just basic or elementary education and the average age was 84.01 years. It was specified that 62.1 percent of them did not present comorbidity. Visual neurosensory (64.4 percent) and auditory (50.6 percent) deficits were identified. Fragility was found in 54.0 percent of the cases as well as indicators of functional dependence on basic activities (73.5 percent) and instrumental activities (93.1 percent). Cognitive deficit was evaluated in 50.6 percent of the cases, and depression was diagnosed in 56.3 percent of them. Conclusions: The older adults included in the study were mainly women with basic or elementary education and an average age of over 80 years. Subjects who did not have comorbidity, those who presented visual and auditory deficit, physical fragility, dependence to perform the basic activities of daily life and the instrumental ones, cognitive deficit, and depression prevailed in the study(AU)

Accelerated Cognitive Ageing in Epilepsy: A Neuropsychological Evaluation of Cognitive Deterioration.

OBJECTIVE: Shed light on cognitive deterioration in Accelerated Cognitive Ageing (ACA) in epilepsy from a neuropsychological point of view in order to improve clinical diagnostics. METHODS: We compared the IQ-profile including GAI, OPIE IV-premorbid IQ and deterioration-scores of 21 epilepsy patients with ACA with 21 matched epilepsy patients without ACA (Epilepsy Controls) and 16 age- and education-matched Healthy Controls. Memory was also evaluated. RESULTS: Premorbid IQs were equal in all groups. Deterioration was apparent in the ACA-group in the WAIS-IV FSIQ and PRI, whereas no deterioration was found in the two control groups. PSI was impaired in both epilepsy groups, though with more impairment seen in the ACA-group. The VCI remained unimpaired. The FSIQ-GAI discrepancy was equal in both patient groups and significantly larger than in the Healthy Controls. WMS-IV memory indices were of average level in all groups. Memory impairment in ACA was not statistically different from the Epilepsy Controls. 85.7% of ACA-patients could be correctly classified through factors DET_FSIQ and PSI. CONCLUSIONS: Cognitive deterioration in ACA is characterized by an average drop of 19 IQ-points in FSIQ and PRI. Verbal abilities remain unimpaired. Impairments in fluid functions compromise cognitive abilities in epilepsy, but only partially contribute to cognitive deterioration in ACA. PSI proved to have some diagnostic value in differentiating epilepsy patients from healthy controls, but fails to differentiate between ACA and Epilepsy Controls. A comparison made between OPIE-IV equations and obtained IQs leads to a significant better detection of cognitive deterioration in epilepsy than the use of GAI-FSIQ discrepancies alone.

Detection of brain amyloid-ß deposits due to the repetitive head trauma in a former karate player.

Head trauma is a well-established epidemiological risk factor for Alzheimer's disease, but a study of early detection of its pathology has not yet been performed in human patients in vivo. To address this issue, we performed 11 C-labelled Pittsburgh compound B-positron emission tomography on a right-handed 30-year-old man with cognitive deterioration after repetitive head trauma during karate matches. Structural magnetic resonance imaging was also performed on this patient. The same positron emission tomography analysis was performed on elderly healthy controls (15 men, mean age: 70.7 ± 6.2 years). To analyze grey matter volume, structural magnetic resonance imaging was performed on age-matched healthy controls (15 men, mean age: 28.5 ± 3.6 years). The cognitive deterioration in our patient was fixed and partially improved in the 10 years after the repetitive head trauma. However, Pittsburgh compound B-non-displaceable binding potential was significantly elevated in the patient. Volume reduction was shown in the medial temporal region, cerebellum, and the basal frontal cortex, while amyloid-ß increase was shown in the bilateral prefrontal cortex. This is the first study to show an early degenerative process due to head trauma in the prefrontal cortex, where structural damage is not yet visible. Early recognition of the degenerative pathology due to repetitive head trauma by amyloid and possibly tau imaging would help clinicians determine how to treat those with early symptoms.

Diet and Brain Health: Which Role for Polyphenols?

BACKGROUND: The aging of western societies is leading to a dramatic increase in the prevalence of chronic conditions, threatening the health status and then the sustainability of our healthcare systems. In particular, dementia is being increasingly recognized as a public health priority, given its enormous socioeconomic burdens further amplified by the absence of treatments really effective in improving the clinical course of the disease. METHODS: The question of whether some degree of cognitive deterioration is an inevitable part of aging or should be considered as a pathological pre-stage of dementia is currently debated. This is a field in need of research because accelerated brain aging as well as further decline in cognition might be preventable in the early stages of cognitive impairment. Herein, we discuss evidence from clinical and experimental studies on the role of polyphenols in preserving cognitive performance across life. RESULTS: In recent years, the possibility of favorably influencing the cognitive trajectory through promotion of lifestyle modifications has been increasingly investigated. In particular, the relationship between nutritional habits and brain health has attracted special attention. Dietary polyphenols exhibit a strong potential to promote brain due to their efficacy in protecting neurons against oxidative stress-induced injury, suppressing neuroinflammation and in ameliorating cardiovascular risk factor control and cardiovascular function thus counteracting neurotoxicity and neurodegeneration. CONCLUSION: Emerging evidence suggest that dietary polyphenols, in particular flavonoids, may exert beneficial effects on the central nervous system thus representing a potential tool to preserve cognitive performance throught senescence.

Duration of untreated psychosis and neurocognitive functioning in first-episode psychosis: a systematic review and meta-analysis.

BACKGROUND: Previous reviews suggest there is minimal evidence for an association between duration of untreated psychosis (DUP) and neurocognition. This is based on tallied findings of studies with small samples and neurocognition viewed as a single construct. We aimed to conduct a systematic review and meta-analysis examining the association between DUP and individual neurocognitive domains and tests in first-episode psychosis (FEP). METHOD: MOOSE and PRISMA guidelines were followed. Forty-three studies involving 4647 FEP patients were included. For studies providing correlations between DUP and neurocognition, 12 separate meta-analyses were performed based on neurocognitive domains/indices. The influence of demographic/clinical variables was tested using weighted linear meta-regression analyses. RESULTS: The relationship between DUP and most neurocognitive domains/indices was not significant. Longer DUP was associated with a larger cognitive deterioration index, i.e. current minus premorbid intellectual functioning (N = 4; mean ES -0.213, 95% confidence interval (CI) (-0.344 to -0.074), p = 0.003). Findings were homogeneous, with no evidence of publication bias or significant influence from moderators. For studies providing mean and standard deviations for neurocognitive measures and DUP, 20 meta-regressions were performed on individual neurocognitive tests. One significant finding emerged showing that longer DUP was associated with fewer Wisconsin Card Sorting Test-perseverative errors (mean ES -0.031, 95% CI (-0.048 to -0.013), p < 0.001). Exploratory meta-regressions in studies with mean DUP <360 days showed longer DUP was significantly associated with poorer performance on Trail Making Test A and B and higher Full-Scale IQ. CONCLUSION: There may not be a generalised association between DUP and neurocognition, however, specific cognitive functions may be associated with longer DUP or delayed help-seeking.

[Associations between cognitive performance in a dementia screening test (SKT) and an intelligence test (WAIS IV) : Which deficits in cognitive performance in old age indicate a possible pathological deterioration process?] / Zusammenhänge zwischen den kognitiven Leistungen in einem Demenzscreening (SKT) und in einem Intelligenztest (WAIS-IV) : Welche kognitiven Leistungseinbußen im Alter sprechen für einen möglichen pathologischen Abbauprozess?

BACKGROUND: Which deficits in cognitive performance indicate the onset of a pathological deterioration process in older persons? AIM AND OBJECTIVES: Based on an established dementia screening test in elderly adults, a differentiation can be made between healthy cognitive performance and the onset of pathological deficits in performance (in the sense of mild cognitive impairment). The aim of the study was to investigate whether cognitive decline assessed with a dementia screening instrument is reflected in an intelligence test for adults. The dementia screening measured disorders in memory and attention, the intelligence testing battery measured information processing, working memory, perceptual reasoning, logical thinking and verbal comprehension. MATERIAL AND METHODS: A total of 253 cognitively healthy, self-dependent and non-dementia persons (129 women and 124 men), aged between 60 and 91 years (M = 71.98 years; SD = ±7.13) were tested with the complete Wechsler adult intelligence scale (WAIS-IV) and the short performance test (SKT), based on the new normalization from 2015. The SKT enables an assessment of the degree of cognitive deterioration based on coloring codes of traffic lights. Green indicates normal aging, yellow mild cognitive impairment and red stands for abnormal cognitive aging. RESULTS AND CONCLUSION: There were significant correlations between the total SKT score as a measure of total cognitive impairment and the indices of the WAIS-IV, such as information processing, working memory and perceptual reasoning. No significant covariation was found for verbal comprehension. The results suggest that in old age cognitive deterioration starts with reduced speed of information processing and impairment in the working memory log before deficits in memory are present. This finding was reflected in significant mean differences between the subjects in the category green versus yellow in the indices information processing and working memory. Under these aspects there were medium effect strengths (d = 0.60) and the second largest (insignificant) differences were shown in working memory (d = 0.39).