scholarly journals Assessment of cognitive impairment and related risk factors in hemodialysis patients

2021 ◽  
Author(s):  
Hristos Karakizlis ◽  
Katharina Bohl ◽  
Jannis Ziemek ◽  
Richard Dodel ◽  
Joachim Hoyer
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Early Stage ◽  
Hemodialysis Patients ◽  
Cognitive Status ◽  
Cognitive Profile ◽  
Cognitive Test ◽  
Regional Government

Abstract Background Cognitive impairment in hemodialysis patients has been acknowledged over the last years and has been reported in up to 80% of patients. Older age, high prevalence of cardiovascular risk factors, such as stroke and transient ischemic attack, uremia, and multiple metabolic disturbances represent the most common factors for cognitive impairment in hemodialysis patients. Methods We conducted a prospective cohort study on 408 patients from 10 hemodialysis centers in the regional government district of Middle Hesse (Germany). Patients underwent a neuropsychological test battery consisting of five tests, in addition to a phonemic fluency test, to assess cognitive profile. The patients were classified into no cognitive impairment mildly-, moderately- or severely-impaired cognitive function, depending on the degree of impairment and number of domains where the deficit was determined. We analyzed the cognitive profile and the change in performance over time in hemodialysis patients based on their cognitive status at baseline vs. 1-year follow-up. Results Of 479 eligible patients, 408 completed all tests at baseline. Only 25% (n = 102) of the patients had no cognitive impairment. Fourteen per cent (n = 57), 36.5% (n = 149), and 24.5% (n = 100) of patients showed mild, moderate, and severe impairment, respectively. In patients with cognitive impairment, all cognitive domains were affected, and impairment was significantly associated with depression and education. The most impaired cognitive performance was immediate memory recall, and the best performance was found in naming ability. No significant  change was observed after 1 year- follow up in any domain. Conclusion Our study shows that the prevalence of cognitive impairment in hemodialysis patients is high and that it is affected by the presence of depression. Furthermore, education has an effect on cognitive test results. As depression has a significant influence on cognitive impairment, its early identification is essential in order to initiate treatment at an early stage, hoping to positively influence cognitive performance. Graphic abstract

scholarly journals ReCODE: A Personalized, Targeted, Multi-Factorial Therapeutic Program for Reversal of Cognitive Decline

Biomedicines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1348
Author(s):  
Rammohan V Rao ◽  
Sharanya Kumar ◽  
Julie Gregory ◽  
Christine Coward ◽  
Sho Okada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Early Stage ◽  
Treatment Strategies ◽  
High Sensitivity ◽  
Rank Test ◽  
Proof Of Concept ◽  
Therapeutic Program

Background: Alzheimer’s disease (AD) is the major cause of age-associated cognitive decline, and in the absence of effective therapeutics is progressive and ultimately fatal, creating a dire need for successful prevention and treatment strategies. We recently reported results of a successful proof-of-concept trial, using a personalized, precision medicine protocol, but whether such an approach is readily scalable is unknown. Objective: In the case of AD, there is not a single therapeutic that exerts anything beyond a marginal, unsustained, symptomatic effect. This suggests that the monotherapeutic approach of drug development for AD may not be an optimal one, at least when used alone. Using a novel, comprehensive, and personalized therapeutic system called ReCODE (reversal of cognitive decline), which proved successful in a small, proof-of-concept trial, we sought to determine whether the program could be scaled to improve cognitive and metabolic function in individuals diagnosed with subjective cognitive impairment, mild cognitive impairment, and early-stage AD. Methods: 255 individuals submitted blood samples, took the Montreal Cognitive Assessment (MoCA) test, and answered intake questions. Individuals who enrolled in the ReCODE program had consultations with clinical practitioners, and explanations of the program were provided. Participants had follow-up visits that included education regarding diet, lifestyle choices, medications, supplements, repeat blood sample analysis, and MoCA testing between 2 and 12 months after participating in the ReCODE program. Pre- and post-treatment measures were compared using the non-parametric Wilcoxon signed rank test. Results and Conclusions: By comparing baseline to follow-up testing, we observed that MoCA scores either significantly improved or stabilized in the entire participant pool—results that were not as successful as those in the proof-of-concept trial, but more successful than anti-amyloid therapies—and other risk factors including blood glucose, high-sensitivity C-reactive protein, HOMA-IR, and vitamin D significantly improved in the participant pool. Our findings provide evidence that a multi-factorial, comprehensive, and personalized therapeutic program designed to mitigate AD risk factors can improve risk factor scores and stabilize or reverse the decline in cognitive function. Since superior results were obtained in the proof-of-concept trial, which was conducted by a small group of highly trained and experienced physicians, it is possible that results from the use of this personalized approach would be enhanced by further training and experience of the practicing physicians. Nonetheless, the current results provide further support indicating the potential of such an approach for the prevention and reversal of cognitive decline.

Abstract P56: Diffusion Tensor Imaging at the Time of Stroke is Associated With Cognitive Performance 4 Months Later

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kyle C Kern ◽  
Clinton B Wright ◽  
Richard Leigh
Keyword(s):  
Cognitive Impairment ◽  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Linear Regression ◽  
Cognitive Performance ◽  
Diffusion Tensor ◽  
Cognitive Status ◽  
Cognitive Testing ◽  
Brain Health

Introduction: Cognitive impairment after stroke is associated with stroke severity and baseline brain health. We hypothesized that acute diffusion tensor imaging (DTI) metrics would identify patients at risk for post-stroke cognitive impairment. Methods: Patients were enrolled prospectively in an observational study that involves serial MRI and cognitive testing in patients with recent stroke and moderate white matter disease on MRI but without dementia. DTI was performed at the time of stroke; cognitive testing with the MOCA and the Telephone Interview for Cognitive Status (TICS) were performed 3 months later. DTI was used to calculate Peak Skeletonized Mean Diffusivity (PSMD), a measure of global white matter microstructural integrity previously validated in cerebral small vessel disease. Fractional anisotropy maps were skeletonized (figure panel A) and a histogram of the corresponding MD values was used to calculate the peak width in the non-stroke hemisphere (panel B). Linear regression was used to test whether acute PSMD in the non-stroke hemisphere, acute stroke volume, or baseline NIHSS predicted cognitive performance 3 months later. Results: Fourteen patients followed-up at a median of 123 days. Patients had a median age of 73 years, mean baseline NIHSS of 1.2 (IQR 0-1.75), mean infarct volume of 4cc (range 0-16cc), mean MOCA of 25 (range 19-30), mean TICS of 33 (range 23-41), and 50% were women. Using multivariable linear regression, only acute PSMD predicted follow-up MOCA (std beta= -0.64, adj R 2 = 0.37, p= 0.013) while compared to baseline NIHSS, PSMD showed a stronger association with follow-up TICS score (std beta= -0.57 vs -0.44, p= 0.017; model adj R 2 = 0.476, p= 0.011)(Panel C). Conclusions: In this cohort of patients with small strokes we found that acute contralateral PSMD provided a measure of brain health that appears to predict cognitive performance at 3 months better than stroke size or severity. These are preliminary findings from an ongoing study.

scholarly journals Predicting Cognitive Decline and Dementia with the Newly Normed SKT Short Cognitive Performance Test

2019 ◽  
Vol 9 (1) ◽  
pp. 184-193 ◽  
Author(s):  
Mark Stemmler ◽  
Johannes Baltasar Hessler ◽  
Horst Bickel
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Performance Test ◽  
Rating Scale ◽  
Cognitive Status ◽  
Traffic Light ◽  
Clinical Dementia Rating ◽  
Kaplan Meier ◽  
Dementia Onset

Objective: The aim of this article was to determine the criterion-related validity of the newly normed SKT (Syndrom-Kurztest) Short Cognitive Performance Test with the onset of dementia as the predicted criterion. Methods: The cognitive ability was tested with the SKT in a sample of 546 cognitively healthy adults aged 65–85 years. New cases of mild cognitive impairment (MCI) or dementia were determined in 3 follow-up investigations at 1-year intervals. Each participant’s cognitive status was rated on the Clinical Dementia Rating Scale. The cognitive status according to the SKT is presented in terms of a traffic light system. Results: Based on Kaplan-Meier estimators, the trajectories of the different SKT traffic light labels were investigated over 3 years. The trajectories were significantly different, representing differential risks for dementia onset. In comparison to the green group, the hazard ratio (HR) for the development of dementia and MCI amounted to HR 6.63 (95% CI 2.75–15.96) and HR 2.34 (95% CI 1.37–3.99), respectively, in the yellow group, and to HR 25.40 (95% CI 10.73–60.14) and HR 3.83 (95% CI 1.86–7.86), respectively, in the red group. Conclusions: The newly normed SKT showed a high predictive validity for the onset of dementia.

scholarly journals Evolution of short cognitive test performance in stroke patients with vascular cognitive impairment and vascular dementia: Baseline evaluation and follow-up

2017 ◽  
Vol 11 (4) ◽  
pp. 381-388 ◽  
Author(s):  
Nilton Custodio ◽  
Rosa Montesinos ◽  
David Lira ◽  
Eder Herrera-Perez ◽  
Yadira Bardales ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Vascular Dementia ◽  
Cognitive Performance ◽  
Vascular Cognitive Impairment ◽  
Cognitive Test ◽  
Stroke Patients ◽  
Clinical Dementia Rating ◽  
Baseline Evaluation ◽  
Box Plot

ABSTRACT. There is limited evidence about the progression of cognitive performance during the post-stroke stage. Objective: To assess the evolution of cognitive performance in stroke patients without vascular cognitive impairment (VCI), patients with vascular mild cognitive impairment (MCI), and patients with vascular dementia (VD). Methods: A prospective cohort of stroke outpatients from two secondary medical centers in Lima, Peru was studied. We performed standardized evaluations at definitive diagnosis (baseline evaluation), and control follow-ups at 6 and 12 months, including a battery of short cognitive tests: Clinical Dementia Rating (CDR), Addenbrooke's Cognitive Examination (ACE), and INECO Frontal Screening (IFS). Results: 152 outpatients completed the follow-up, showing progressive increase in mean score on the CDR(0.34 to 0.46), contrary to the pattern observed on the ACE and IFS (78.18 to 76.48 and 23.63 to 22.24). The box plot for the CDR test showed that VCI patients had progressive worsening (0.79 to 0.16). Conversely, this trend was not observed in subjects without VCI. The box plot for the ACE and IFS showed that, for the majority of the differentiated stroke types, both non-VCI and VCI patients had progressive worsening. Conclusion: According to both ACE and IFS results during a 1-year follow-up, the cognitive performance of stroke patients worsened, a trend which was particularly consistent in infarction-type stroke patients.

scholarly journals Resting heart rate variability as a possible marker of cognitive decline

Kinesiology ◽  
2020 ◽  
Vol 52 (1) ◽  
pp. 72-84
Author(s):  
Bernhard Grässler ◽  
Anita Hökelmann ◽  
Richard Halti Cabral
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Nervous System ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
Processing Speed ◽  
Early Stage ◽  
Cognitive Test

Cognition is a major subject to be addressed nowadays due to the increasing number of cognitively affected people in most societies. Because of a lack of pharmaceutical therapies treating cognitive decline, its indicators should be diagnosed before it becomes prevalent. Scientific evidence indicates a relationship between cognition and the nervous system, especially its autonomic part. Heart rate variability (HRV) as an indicator of the autonomic nervous system functioning has been studied as a biological marker for the evaluation of cognitive performance. Therefore, HRV is a possible indicator of cognitive impairment. The aim was to provide a systematic literature review about the association between resting HRV and the cognitive performance. Five cognitive functions were analysed separately: executive functions, memory and learning, language abilities, visuospatial functioning, and processing speed. Furthermore, the global cognitive function evaluated with cognitive test batteries was considered too. An electronic database search was conducted with five databases. Three search fields comprised HRV, cognitive performance, and adult subjects. The final dataset consisted of 27 articles. Significant correlations in each cognitive function were found, except for processing speed, suggesting a positive association between resting HRV and cognitive performance. Mechanisms underlying this association between cardiovascular health and cognition are discussed. For the future, HRV could be used in diagnostics as an indicator of cognitive impairment before symptoms of dementia get apparent. With a timely diagnosis, preventative tools could be initiated at an early stage of dementia.

scholarly journals Cognitive Impairment Is Not a Predictor of Failure to Adhere to Anticoagulation of Stroke Patients with Atrial Fibrillation

2015 ◽  
Vol 39 (5-6) ◽  
pp. 325-331 ◽  
Author(s):  
Solveig Horstmann ◽  
Timolaos Rizos ◽  
Michaela Saribas ◽  
Evdokia Efthymiou ◽  
Geraldine Rauch ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Functional Status ◽  
Cognitive Performance ◽  
Functional Disability ◽  
Cognitive Status ◽  
Stroke Severity ◽  
Detailed Medical History

Background: Oral anticoagulation (OAC) with vitamin K antagonists (VKA) or direct oral anticoagulants (DOAC) is an effective strategy that is used for stroke prevention in patients with atrial fibrillation (AF). However, OAC is underused particularly in elderly patients, who are often physically disabled or cognitively impaired. We aimed at evaluating the effect of cognitive status and disability on OAC adherence 1 year after stroke or TIA. Methods: In this prospective, single-center, observational study patients with ischemic stroke or TIA were consecutively included between 3/2011 and 9/2012. The detailed medical history, basic demographic variables, cardiovascular risk factors, stroke severity according to the National Institutes of Health Stroke Scale (NIHSS), medication including OAC were all recorded. Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) score at baseline. The functional status was assessed by recording activities and instrumental activities of daily living, respectively (ADL, IADL). After 12 months, patients had a follow-up visit to reassess the cognitive and functional status (MoCA, ADL and IADL) and to document the current use of OAC. Results: In total, 12 months after the ischemic stroke or TIA AF had been diagnosed in 160/586 (27.3%). Of these, 151 patients (94.4%) were treated with OAC. OAC was performed using VKA in 79/151 (52.3%) and DOACs in 72/151 (47.7%). Cognitive impairment at 12 months follow-up was not associated with the absence of OAC treatment. However, regression analysis revealed that patients with AF with physical (ADL) and functional disability (IADL) were less likely to be treated with OAC (p = 0.08 and p = 0.04, respectively) 12 months after a stroke. None of these two factors, however, was independently associated with nonadherence to OAC 12 months after stroke. Although cognitive performance was similar in patients receiving VKA and direct anticoagulants (DOAC), adherence to VKA tended to be lower (82.6 vs. 94.6%, p = 0.12). Conclusions: In stroke and TIA patients with AF, the multifactorial medical and functional constellation rather than cognitive impairment specifically can be an obstacle for long-term OAC.

Elucidating the risk factors for progression from amyloid-negative amnestic mild cognitive impairment to dementia

2020 ◽  
Vol 17 ◽  
Author(s):  
Hyung-Ji Kim ◽  
Jae-Hong Lee ◽  
E-nae Cheong ◽  
Sung-Eun Chung ◽  
Sungyang Jo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Amnestic Mild Cognitive Impairment ◽  
Amyloid Pet ◽  
Clinical Progression ◽  
Amnestic Mci

Background: Amyloid PET allows for the assessment of amyloid β status in the brain, distinguishing true Alzheimer’s disease from Alzheimer’s disease-mimicking conditions. Around 15–20% of patients with clinically probable Alzheimer’s disease have been found to have no significant Alzheimer’s pathology on amyloid PET. However, a limited number of studies had been conducted this subpopulation in terms of clinical progression. Objective: We investigated the risk factors that could affect the progression to dementia in patients with amyloid-negative amnestic mild cognitive impairment (MCI). Methods: This study was a single-institutional, retrospective cohort study of patients over the age of 50 with amyloidnegative amnestic MCI who visited the memory clinic of Asan Medical Center with a follow-up period of more than 36 months. All participants underwent brain magnetic resonance imaging (MRI), detailed neuropsychological testing, and fluorine-18[F18]-florbetaben amyloid PET. Results: During the follow-up period, 39 of 107 patients progressed to dementia from amnestic MCI. In comparison with the stationary group, the progressed group had a more severe impairment in verbal and visual episodic memory function and hippocampal atrophy, which showed an Alzheimer’s disease-like pattern despite the lack of evidence for significant Alzheimer’s disease pathology. Voxel-based morphometric MRI analysis revealed that the progressed group had a reduced gray matter volume in the bilateral cerebellar cortices, right temporal cortex, and bilateral insular cortices. Conclusion: Considering the lack of evidence of amyloid pathology, clinical progression of these subpopulation may be caused by other neuropathologies such as TDP-43, abnormal tau or alpha synuclein that lead to neurodegeneration independent of amyloid-driven pathway. Further prospective studies incorporating biomarkers of Alzheimer’s diseasemimicking dementia are warranted.

Analyses of Visuospatial and Visuoperceptual Errors as Predictors of Dementia in Parkinson’s Disease Patients with Subjective Cognitive Decline and Mild Cognitive Impairment

2020 ◽  
pp. 1-11
Author(s):  
Iván Galtier ◽  
Antonieta Nieto ◽  
María Mata ◽  
Jesús N. Lorenzo ◽  
José Barroso
Keyword(s):  
Risk Factors ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Poor Performance ◽  
Subjective Cognitive Decline ◽  
Independent Risk Factors

ABSTRACT Objective: Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) in Parkinson’s disease (PD) are considered as the risk factors for dementia (PDD). Posterior cortically based functions, such as visuospatial and visuoperceptual (VS-VP) processing, have been described as predictors of PDD. However, no investigations have focused on the qualitative analysis of the Judgment of Line Orientation Test (JLOT) and the Facial Recognition Test (FRT) in PD-SCD and PD-MCI. The aim of this work was to study the VS-VP errors in JLOT and FRT. Moreover, these variables are considered as predictors of PDD. Method: Forty-two PD patients and 19 controls were evaluated with a neuropsychological protocol. Patients were classified as PD-SCD and PD-MCI. Analyses of errors were conducted following the procedure described by Ska, Poissant, and Joanette (1990). Follow-up assessment was conducted to a mean of 7.5 years after the baseline. Results: PD-MCI patients showed a poor performance in JLOT and FRT total score and made a greater proportion of severe intraquadrant (QO2) and interquadrant errors (IQO). PD-SCD showed a poor performance in FRT and made mild errors in JLOT. PD-MCI and QO2/IQO errors were independent risk factors for PDD during the follow-up. Moreover, the combination of both PD-MCI diagnosis and QO2/IQO errors was associated with a greater risk. Conclusions: PD-MCI patients presented a greater alteration in VS-VP processing observable by the presence of severe misjudgments. PD-SCD patients also showed mild difficulties in VS-SP functions. Finally, QO2/IQO errors in PD-MCI are a useful predictor of PDD, more than PD-MCI diagnosis alone.

OBJECTIVE COGNITIVE IMPAIRMENT AND PROGRESSION TO DEMENTIA IN WOMEN: THE PROSPECTIVE EPIDEMIOLOGICAL RISK FACTOR STUDY

2017 ◽  
pp. 1-7
Author(s):  
J. Skov Neergaard ◽  
K. Dragsbæk ◽  
C. Christiansen ◽  
M. Asser Karsdal ◽  
S. Brix ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Elderly Women ◽  
Population Based ◽  
Risk Factor Study ◽  
Factor Study ◽  
Epidemiological Risk ◽  
Epidemiological Risk Factor ◽  
History Of

Background: Identification of subjects with a progressive disease phenotype is an urgent need in the pharmaceutical industry where most of the recent clinical trials in Alzheimer’s disease have failed. Objectives: The objective of this study was to identify subgroups of individuals with objective cognitive impairment (OCI), who were most likely to progress to dementia and to identify the risk factors associated with progression. Design: Prospective cohort study. Setting: Population-based. Participants: 5,380 elderly women from Denmark. Measurements: The Short Blessed Test and a category fluency test with animal naming, was used to assess cognitive function, and to classify them into different groups of OCI. Results: OCI was identified in 852 subjects at baseline. The risk of dementia was elevated for OCI subjects as compared to subjects with normal cognition (HR 1.46[1.19-1.79]). The courses of OCI were studied in a sub-cohort who completed the cognitive assessment at both the baseline and the follow-up visit (n = 1,933). Of these subjects 203 had OCI at baseline. The multi-domain subtypes of OCI were associated with progressive OCI. Subjects most likely to progress were older, physically inactive, had a higher level of total cholesterol (>6.5 mmol/L) and had a history of depression as compared to subjects with a non-progressive course of OCI. Conclusions: In this cohort we identified a risk profile associated with progression from OCI in older women. The degree of impairment at baseline was an important predictor of conversion to dementia, additionally several modifiable risk factors were associated with progression.

scholarly journals Facets of Conscientiousness and risk of dementia

2017 ◽  
Vol 48 (6) ◽  
pp. 974-982 ◽  
Author(s):  
A. R. Sutin ◽  
Y. Stephan ◽  
A. Terracciano
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Personality Assessment ◽  
Genetic Risk ◽  
Cox Regression ◽  
Genetic Risk Factors ◽  
Self Control ◽  
Standard Deviation Increase ◽  
Study Participants

BackgroundMultiple studies have found Conscientiousness to be protective against dementia. The purpose of this study is to identify which specific aspects, or facets, of Conscientiousness are most protective against cognitive impairment and whether these associations are moderated by demographic factors and/or genetic risk.MethodsHealth and Retirement Study participants were selected for analysis if they completed the facets of Conscientiousness measure, scored in the range of normal cognitive functioning at the baseline personality assessment, and had at least one follow-up assessment of cognition over the up to 6-year follow-up (N = 11 181). Cox regression was used to test for risk of incident dementia and risk of incident cognitive impairment not dementia (CIND).ResultsOver the follow-up, 278 participants developed dementia and 2186 participants developed CIND. The facet of responsibility had the strongest and most consistent association with dementia risk: every standard deviation increase in this facet was associated with a nearly 35% decreased risk of dementia; self-control and industriousness were also protective. Associations were generally similar when controlling for clinical, behavioral, and genetic risk factors. These three facets were also independent predictors of decreased risk of CIND.ConclusionsThe present research indicates that individuals who see themselves as responsible, able to control their behavior, and hard workers are less likely to develop CIND or dementia and that these associations persist after accounting for some common clinical, behavioral, and genetic risk factors.

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