Cognitive Impairment in Moderate Degree Diffuse Axonal Head Injuries: Analysis of 84 Cases Using MMSE

Abstract Background Cognitive impairment is commonly seen in traumatic brain injury survivors. Posttraumatic cognitive sequelae may be more devastating than focal motor and focal sensory deficits, and are usually left unattended. Aim and Objective Aim of this study was to assess cognitive impairment in patients who had sustained moderate degree diffuse axonal injuries and having good outcome (Glasgow Outcome Score of 5). Methods and Materials Prospective observational study was done from 2011 to 2015 on the patients who had sustained moderated degree diffuse brain injuries. Eighty-four cases fulfilling the inclusion criteria were studied. Patients were assessed with Mini-Mental Status Examination at discharge, end of 1 month, and at 3 months. Result Seventy-six were males and 8 were females. Age ranged from 16 to 49 years. Note that 4.76% (4) patients had hypotension at presentation, 32.14% (27) patients had associated injuries, and 19.04% (16) patients had hyponatremia at presentation. Diabetes mellitus was seen in 34.52% (29) patients, while hypertension was seen in 14.28% (12). At 3 months’ follow-up, 19.06% (16) patients had cognitive impairment. The present study revealed that hypotension and presence of associated injuries at presentation raises the odds of having cognitive impairment by 8 and 5 times, respectively. Conclusion Routine assessment of cognitive impairment in head injury survivors is essential as it may help in identifying cognitive deficits. Early intervention of neurorehabilitation to such patients results in better neurocognitive outcome. Hypotension and associated injuries are associated with poor cognitive outcome.

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Degree of cognitive impairment and mortality: a 17-year follow-up in a community study

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796014000390 ◽

2014 ◽

Vol 24 (6) ◽

pp. 503-511 ◽

Cited By ~ 8

Author(s):

J. Santabárbara ◽

R. Lopez-Anton ◽

G. Marcos ◽

C. De-la-Cámara ◽

E. Lobo ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mortality Risk ◽

Community Sample ◽

Population Attributable Fraction ◽

Moderate Degree ◽

Mild Degree ◽

Mini Mental Status Examination ◽

Severe Degree

Background.To test the hypothesis that cognitive impairment in older adults is associated with all-cause mortality risk and the risk increases when the degree of cognitive impairment augments; and then, if this association is confirmed, to report the population-attributable fraction (PAF) of mortality due to cognitive impairment.Method.A representative random community sample of individuals aged over 55 was interviewed, and 4557 subjects remaining alive at the end of the first year of follow-up were included in the analysis. Instruments used in the assessment included the Mini-Mental Status Examination (MMSE), the History and Aetiology Schedule (HAS) and the Geriatric Mental State (GMS)-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. Mortality information was obtained from the official population registry. Multivariate Cox proportional hazard models were used to test the association between MMSE degrees of cognitive impairment and mortality risk. We also estimated the PAF of mortality due to specific MMSE stages.Results.Cognitive impairment was associated with mortality risk, the risk increasing in parallel with the degree of cognitive impairment (Hazard ratio, HR: 1.18 in the ‘mild’ degree of impairment; HR: 1.29 in the ‘moderate’ degree; and HR: 2.08 in the ‘severe’ degree). The PAF of mortality due to severe cognitive impairment was 3.49%.Conclusions.A gradient of increased mortality-risk associated with severity of cognitive impairment was observed. The results support the claim that routine assessment of cognitive function in older adults should be considered in clinical practice.

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Structural brain injury in sports-related concussion

Neurosurgical FOCUS ◽

10.3171/2012.10.focus12279 ◽

2012 ◽

Vol 33 (6) ◽

pp. E6 ◽

Cited By ~ 13

Author(s):

Scott L. Zuckerman ◽

Andrew Kuhn ◽

Michael C. Dewan ◽

Peter J. Morone ◽

Jonathan A. Forbes ◽

...

Keyword(s):

Brain Injury ◽

Literature Review ◽

Brain Injuries ◽

Case Reports ◽

Head Injuries ◽

Health Concern ◽

Prevalence Data ◽

Small Series ◽

Structural Brain

Object Sports-related concussions (SRCs) represent a significant and growing public health concern. The vast majority of SRCs produce mild symptoms that resolve within 1–2 weeks and are not associated with imaging-documented changes. On occasion, however, structural brain injury occurs, and neurosurgical management and intervention is appropriate. Methods A literature review was performed to address the epidemiology of SRC with a targeted focus on structural brain injury in the last half decade. MEDLINE and PubMed databases were searched to identify all studies pertaining to structural head injury in sports-related head injuries. Results The literature review yielded a variety of case reports, several small series, and no prospective cohort studies. Conclusions The authors conclude that reliable incidence and prevalence data related to structural brain injuries in SRC cannot be offered at present. A prospective registry collecting incidence, management, and follow-up data after structural brain injuries in the setting of SRC would be of great benefit to the neurosurgical community.

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Abstract 316: Younger Age Increases Risk of Self-reported Affective and Cognitive Sequelae Six Months Post Cardiac Arrest

Circulation ◽

10.1161/circ.142.suppl_4.316 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Lars Evald ◽

Kolbjorn Bronnick ◽

Christophe Henri Valdemar Duez ◽

Anni Jeppesen ◽

Anders Morten Grejs ◽

...

Keyword(s):

Cardiac Arrest ◽

Cognitive Impairment ◽

Acute Care ◽

Target Temperature Management ◽

Treatment Allocation ◽

Affective Outcomes ◽

Cognitive Failures ◽

Younger Age ◽

Cognitive Sequelae

Introduction: Self-reported affective and cognitive sequelae are frequently reported in cardiac arrest survivors; however, little is known about the risk factors. Hypothesis: We assessed the hypothesis that self-reported (subjective) affective and cognitive outcomes six months after OHCA may be associated with demography, acute care and cerebral outcome. Methods: This is a sub study of the multicenter “Target Temperature Management for 48 vs. 24 hours and Neurologic Outcome after Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial” (the TTH48 trial) investigating the effect of prolonged TTM (24h vs 48h) at 33±1°C. Patients with good outcome on the Cerebral Performances Categories (CPC score≤2) were invited to answer questionnaires on anxiety, depression, emotional distress, perceived stress and cognitive failures six months after OHCA. Multivariate regression analyses were used to test the possible predictors of self-reported outcomes six months follow-up added successively in three blocks: [1] demography (age and gender), [2] acute care (time to ROSC and allocated treatment (24h vs 48h TTM)) and [3] cerebral outcome (objective cognitive impairment and CPC score). Results: A total of 79 out of 107 eligible patients were included in the analysis. There were no significant differences in baseline characteristics between the included group and the group lost to follow-up. [1] Younger age was a significant predictor across all self-reported outcomes, even when controlling for gender, ROSC time, treatment allocation, cognitive impairment and global outcome (CPC). Female gender was a predictor of anxiety, though this should be interpreted cautiously as only eight women participated. [2] ROSC time predicted self-reported cognitive failures, when not controlling for block 3. Treatment allocation had no predictive value. [3] Objective cognitive impairment was not a predictor of self-reported affective or cognitive sequelae. The CPC score was a significant predictor of self-reported affective outcomes, albeit not for self-reported cognitive failures. Conclusion: Younger age was a significant risk factor for self-reported affective and cognitive sequelae six months post OHCA. The CPC score may be a proxy for self-reported affective outcomes.

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Nonimmersive Brain Gaming for Older Adults With Cognitive Impairment: A Scoping Review

The Gerontologist ◽

10.1093/geront/gny164 ◽

2019 ◽

Vol 59 (6) ◽

pp. e764-e781 ◽

Cited By ~ 5

Author(s):

Pallavi Sood ◽

Sandra L Kletzel ◽

Shilpa Krishnan ◽

Hannes Devos ◽

Ahmed Negm ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Scoping Review ◽

Research Field ◽

Cognitive Outcome ◽

Future Research ◽

Eligibility Criteria ◽

Technological Advances ◽

Design And Methods

Abstract Background Technological advances have allowed a variety of computerized cognitive training tools to be engineered in ways that are fun and entertaining yet challenging at a level that can maintain motivation and engagement. This revolution has created an opportunity for gerontological scientists to evaluate brain gaming approaches to improve cognitive and everyday function. The purpose of this scoping review is to provide a critical overview of the existing literature on nonimmersive, electronic brain gaming interventions in older adults with mild cognitive impairment or dementia. Research Design and Methods Systematic search was conducted using 7 electronic databases from inception through July 2017. A comprehensive 2-level eligibility process was used to identify studies for inclusion based on PRISMA guidelines. Results Seventeen studies met eligibility criteria. Majority of the studies were randomized controlled trials (n = 13) and incorporated an active control (n = 9). Intervention doses ranged from 4 to 24 weeks in duration with an average of 8.4 (±5.1 standard deviation [SD]) weeks. Session durations ranged from 30 to 100 min with an average of 54 (±25 SD) minutes. Nearly half of studies included a follow-up, ranging from 3 months to 5 years (n = 8). For most studies, brain gaming improved at least one cognitive outcome (n = 12); only one study reported improvement in activities of daily living. Discussion and Implications This scoping review conveys the breadth of an emerging research field, which will help guide future research to develop standards and recommendations for brain gaming interventions which are currently lacking.

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The neuropsychological sequelae of delirium in elderly patients with hip fracture three months after hospital discharge

International Psychogeriatrics ◽

10.1017/s1041610213000574 ◽

2013 ◽

Vol 25 (9) ◽

pp. 1521-1531 ◽

Cited By ~ 17

Author(s):

Joost Witlox ◽

Chantal J. Slor ◽

René W.M.M. Jansen ◽

Kees J. Kalisvaart ◽

Mireille F.M. van Stijn ◽

...

Keyword(s):

Cognitive Impairment ◽

Hip Fracture ◽

Episodic Memory ◽

Hospital Discharge ◽

Depressive Symptomatology ◽

Poor Performance ◽

Cognitive Outcome ◽

Neuropsychological Sequelae ◽

Global Cognition

ABSTRACTBackground: Delirium is a risk factor for long-term cognitive impairment and dementia. Yet, the nature of these cognitive deficits is unknown as is the extent to which the persistence of delirium symptoms and presence of depression at follow-up may account for the association between delirium and cognitive impairment at follow-up. We hypothesized that inattention, as an important sign of persistent delirium and/or depression, is an important feature of the cognitive profile three months after hospital discharge of patients who experienced in-hosptial delirium.Methods: This was a prospective cohort study. Fifty-three patients aged 75 years and older were admitted for surgical repair of acute hip fracture. Before the surgery, baseline characteristics, depressive symptomatology, and global cognitive performance were documented. The presence of delirium was assessed daily during hospital admission and three months after hospital discharge when patients underwent neuropsychological assessment.Results: Of 27 patients with in-hospital delirium, 5 were still delirious after three months. Patients with in-hospital delirium (but free of delirium at follow-up) showed poorer performance than patients without in-hospital delirium on tests of global cognition and episodic memory, even after adjustment for age, gender, and baseline cognitive impairment. In contrast, no differences were found on tests of attention. Patients with in-hospital delirium showed an increase of depressive symptoms after three months. However, delirium remained associated with poor performance on a range of neuropsychological tests among patients with few or no signs of depression at follow-up.Conclusion: Elderly hip fracture patients with in-hospital delirium experience impairments in global cognition and episodic memory three months after hospital discharge. Our results suggest that inattention, as a cardinal sign of persistent delirium or depressive symptomatology at follow-up, cannot fully account for the poor cognitive outcome associated with delirium.

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Traumatic brain injuries in mixed martial arts: A systematic review

Trauma ◽

10.1177/1460408617740902 ◽

2017 ◽

Vol 20 (4) ◽

pp. 245-254 ◽

Cited By ~ 5

Author(s):

Joel Lockwood ◽

Liam Frape ◽

Steve Lin ◽

Alun Ackery

Keyword(s):

Systematic Review ◽

Martial Arts ◽

Brain Injuries ◽

Head Injuries ◽

Mixed Martial Arts ◽

Ovid Medline ◽

Reduction Strategies ◽

Long Term Follow Up

Introduction Mixed martial arts is an emerging combat sport that is gaining popularity worldwide. We systematically reviewed the literature regarding the prevalence, severity and risk factors of head injuries sustained in mixed martial arts activities. Methods We conducted a comprehensive systematic review of Ovid MEDLINE, Embase, PsycINFO, EBM Reviews, CINAHL, SPORTDiscus, and Web of Science from 1990 to 2016 for studies of any design that reported associations of acute or chronic head injuries in persons participating in mixed martial arts activities. Results The initial database search yielded a total 472 citations, including 264 unique citations after duplications were removed. A total of 18 articles, primarily of observational data, showed ‘technical knockouts’ and ‘knockouts’ are prevalent in this sport (range: 28.3–46.2% of all matches) with other studies showing the lifetime average of 6.2 technical knockouts or knockouts in a career. Studies used inconsistent reporting methods for concussion, and no information regarding long-term follow-up was available. Conclusion Mixed martial arts fighting may be associated with repetitive head injuries and potential long-term neurological consequences; however, data on this topic are poor. Larger studies and stringent medical oversight are needed to improve the management and understanding of mixed martial arts head injuries, with implementation of harm reduction strategies and/or rule modifications to prevent long-term neurological sequelae. Systematic Review Registration: PROSPERO – CRD42014010019.

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Association of Estimated Cardiorespiratory Fitness with the Incidence of Cognitive Impairment in Middle-Aged and Older Adults: Based on 12 Years Follow-Up Data from the Korean Longitudinal Study of Aging

Exercise Science ◽

10.15857/ksep.2021.30.1.16 ◽

2021 ◽

Vol 30 (1) ◽

pp. 16-24

Author(s):

Inhwan Lee ◽

Munku Song ◽

Hyunsik Kang

Keyword(s):

Cognitive Impairment ◽

Longitudinal Study ◽

Older Women ◽

Cardiorespiratory Fitness ◽

Independent Predictor ◽

Regression Analyses ◽

Middle Aged ◽

Mini Mental Status Examination ◽

Mental Status Examination

PURPOSE:This study investigated association of estimated cardiorespiratory fitness (eCRF) with the incidence of cognitive impairment in Korean middle-aged and older adults.METHODS:Total of 4,239 subjects (53% women) aged ≥45 years, who participated in the Korean longitudinal study of aging (KLoSA) were included. Participants were classified into 4 categories from the lowest quartile to the highest quartile based on eCRF distribu¬tions. Korean version of mini-mental status examination (K-MMSE) was used to assessed mild cognitive impairment (MCI) and severe cognitive impairment (SCI). Cox’s proportional regression analyses were used to determine the hazard ratio (HR) and 95% confidence interval (CI) of eCRF categories for having MCI and SCI.RESULTS: During 12-years of follow-up, there were 736 (17.4%) and 272 (6.4%) cases of incidence from MCI and SCI, respectively. In women, compared to the quartile 1 group (reference, HR=1), the quartile 4 group had significantly lower HRs of having incidence of MCI/SCI (HR=0.72, 95% CI=0.55-0.94, p=.015) and MCI (HR=0.73, 95% CI=0.54-0.99, p=.045). However, in men, eCRF was not associated with incidence of cognitive impairment.CONCLUSIONS:The current findings suggest that eCRF may be an independent predictor of cognitive impairment in middle-aged and older women.

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Abstract W P382: Cognitive Outcome in SAMMPRIS: Medical Therapy vs. Stenting

Stroke ◽

10.1161/str.46.suppl_1.wp382 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Alison P Smock ◽

Tanya N Turan ◽

George A Cotsonis ◽

Michael J Lynn ◽

Colin P Derdeyn ◽

...

Keyword(s):

Cognitive Impairment ◽

Repeated Measures ◽

Mixed Model ◽

Cerebral Arteries ◽

Cognitive Outcome ◽

Chi Square ◽

Treatment Groups ◽

Angioplasty And Stenting ◽

Time Point

Background: It has been hypothesized that revascularization of stenotic cerebral arteries may improve cognitive outcome by increasing cerebral perfusion. We sought to compare cognitive outcome in patients treated with percutaneous angioplasty and stenting (PTAS) and aggressive medical management (AMM) vs. AMM alone in the SAMMPRIS Trial. Methods: In SAMMPRIS, 451 patients with recent TIA or stroke attributed to 70%-99% intracranial stenosis were randomized to PTAS plus AMM or AMM alone. Patients with stroke as the qualifying event who had a NIHSS indicating aphasia or neglect were excluded from these analyses. Patients with any ischemic stroke, cerebral infarct with temporary signs (CITS), or ICH during follow-up were excluded from subsequent follow-up visit analyses. The Montreal Cognitive Assessment (MoCA) score was used to assess cognition at baseline, 4 months, 12 months, and closeout (mean 3.05 years in AMM group and 3.12 years in PTAS group). Cognitive impairment was defined as MoCA <26. Mean MoCA scores and the percentage of patients with cognitive impairment were compared between treatment groups at each time point using t-tests and Chi-square tests. Differences in MoCA means from baseline to follow-up time points were compared using mixed model repeated measures ANOVA and Tukey-Kramer tests. Results: As shown in the Figure, there were no significant differences between the treatment groups for mean MoCA at any time point. There were significant improvements in mean MoCA from baseline to 4 months, 12 months, and closeout in both groups. The percentage of patients with cognitive impairment in the AMM vs. PTAS groups were not significantly different at baseline (53 vs. 56%), 4 months (38 vs. 44%), 12 months (42 vs. 40%), and closeout (43 vs. 39%). Conclusions: Revascularization did not provide any additional cognitive benefit over AMM alone in SAMMPRIS even after excluding patients who had cerebral infarction or ICH during follow-up.

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Association of 24-Hour Ambulatory Blood Pressure Patterns with Cognitive Function and Physical Functioning in CKD

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.10570919 ◽

2020 ◽

Vol 15 (4) ◽

pp. 455-464 ◽

Cited By ~ 1

Author(s):

Lama Ghazi ◽

Kristine Yaffe ◽

Manjula K. Tamura ◽

Mahboob Rahman ◽

Chi-yuan Hsu ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Physical Function ◽

Discrete Models ◽

Masked Hypertension ◽

Cross Sectional ◽

Mini Mental Status Examination ◽

Adjusted Model ◽

Blood Pressure Patterns

Background and objectivesHypertension is highly prevalent in patients with CKD as is cognitive impairment and frailty, but the link between them is understudied. Our objective was to determine the association between ambulatory BP patterns, cognitive function, physical function, and frailty among patients with nondialysis-dependent CKD.Design, setting, participants, & measurementsAmbulatory BP readings were obtained on 1502 participants of the Chronic Renal Insufficiency Cohort. We evaluated the following exposures: (1) BP patterns (white coat, masked, sustained versus controlled hypertension) and (2) dipping patterns (reverse, extreme, nondippers versus normal dippers). Outcomes included the following: (1) cognitive impairment scores from the Modified Mini Mental Status Examination of <85, <80, and <75 for participants <65, 65–79, and ≥80 years, respectively; (2) physical function, measured by the short physical performance battery (SPPB), with higher scores (0–12) indicating better functioning; and (3) frailty, measured by meeting three or more of the following criteria: slow gait speed, muscle weakness, low physical activity, exhaustion, and unintentional weight loss. Cognitive function and frailty were assessed at the time of ambulatory BP (baseline) and annually thereafter. SPPB was assessed at baseline logistic and linear regression and Cox discrete models assessed the cross-sectional and longitudinal relationship between dipping and BP patterns and outcomes.ResultsMean age of participants was 63±10 years, 56% were male, and 39% were black. At baseline, 129 participants had cognitive impairment, and 275 were frail. Median SPPB score was 9 (interquartile range, 7–10). At baseline, participants with masked hypertension had 0.41 (95% CI, −0.78 to −0.05) lower SPPB scores compared with those with controlled hypertension in the fully adjusted model. Over 4 years of follow-up, 529 participants had incident frailty, and 207 had incident cognitive impairment. After multivariable adjustment, there was no association between BP or dipping patterns and incident frailty or cognitive impairment.ConclusionsIn patients with CKD, dipping and BP patterns are not associated with incident or prevalent cognitive impairment or prevalent frailty.

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Staging cognitive impairment and incidence of dementia

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796015000918 ◽

2015 ◽

Vol 25 (6) ◽

pp. 562-572 ◽

Cited By ~ 3

Author(s):

J. Santabárbara ◽

R. Lopez-Anton ◽

P. Gracia-García ◽

C. De-la-Cámara ◽

D. Vaquero-Puyuelo ◽

...

Keyword(s):

Cognitive Impairment ◽

Community Sample ◽

Two Phase ◽

Dementia Risk ◽

Incident Dementia ◽

Increased Risk ◽

Severe Impairment ◽

Mini Mental Status Examination ◽

Staging Model

Aims.In a background of interest in staging models in psychiatry, we tested the validity of a simple staging model of cognitive impairment to predict incident dementia.Method.A large community sample of adults aged ≥55 years (N = 4803) was assessed in the baseline of a longitudinal, four-wave epidemiological enquiry. A two-phase assessment was implemented in each wave, and the instruments used included the Mini-Mental Status Examination (MMSE); the History and Aetiology Schedule and the Geriatric Mental State-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. A panel of psychiatrists diagnosed cases of dementia according to DSM-IV criteria, and cases and sub-cases of dementia were excluded for the follow-up waves. Competing risk regression models, adjusted by potential confounders, were used to test the hypothesised association between MMSE levels and dementia risk.Results.Out of the 4057 participants followed up, 607 (14.9%) were classified as ‘normal’ (no cognitive impairment), 2672 (65.8%) as ‘questionable’ cognitive impairment, 732 (18.0%) had ‘mild’ cognitive impairment, 38 (0.9%) had ‘moderate’ cognitive impairment and eight (0.2%) had ‘severe’ impairment.Cognitive impairment was associated with risk of dementia, the risk increasing in parallel with the level of impairment (hazard ratio: 2.72, 4.78 and 8.38 in the ‘questionable’, ‘mild’ and ‘moderate’ level of cognitive impairment, respectively).Conclusions.The documented gradient of increased risk of dementia associated with the severity level of cognitive impairment supports the validity of the simple staging model based on the MMSE assessment.

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