Hearing and dementia: from ears to brain

Abstract The association between hearing impairment and dementia has emerged as a major public health challenge, with significant opportunities for earlier diagnosis, treatment and prevention. However, the nature of this association has not been defined. We hear with our brains, particularly within the complex soundscapes of everyday life: neurodegenerative pathologies target the auditory brain, and are therefore predicted to damage hearing function early and profoundly. Here we present evidence for this proposition, based on structural and functional features of auditory brain organization that confer vulnerability to neurodegeneration, the extensive, reciprocal interplay between ‘peripheral’ and ‘central’ hearing dysfunction, and recently characterized auditory signatures of canonical neurodegenerative dementias (Alzheimer’s disease, Lewy body disease and frontotemporal dementia). Moving beyond any simple dichotomy of ear and brain, we argue for a reappraisal of the role of auditory cognitive dysfunction and the critical coupling of brain to peripheral organs of hearing in the dementias. We call for a clinical assessment of real-world hearing in these diseases that moves beyond pure tone perception to the development of novel auditory ‘cognitive stress tests’ and proximity markers for the early diagnosis of dementia and management strategies that harness retained auditory plasticity.

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Use of the Nursing Outcomes Classification - NOC to assess the knowledge of patients with venous ulcer

Revista Gaúcha de Enfermagem ◽

10.1590/1983-1447.2020.20190146 ◽

2020 ◽

Vol 41 (spe) ◽

Author(s):

Viviane Maria Osmarin ◽

Fernanda Guarilha Boni ◽

Taline Bavaresco ◽

Amália de Fátima Lucena ◽

Isabel Cristina Echer

Keyword(s):

Chronic Disease ◽

Disease Management ◽

Chronic Disease Management ◽

Management Strategies ◽

Venous Ulcer ◽

Cross Sectional Study ◽

Cross Sectional ◽

Nursing Outcomes ◽

Treatment And Prevention ◽

Nursing Outcomes Classification

Abstract Objective: To evaluate the knowledge of patients with venous ulcers (VU) on their chronic disease, treatment, and prevention of complications, according to the Nursing Outcomes Classification-NOC. Methods: This is a cross-sectional study conducted between 2017 and 2018 in a Brazilian hospital. The sample consisted of 38 patients with VU attended in outpatient nursing consultations. The study analyzed sociodemographic, clinical and nine indexes from the Knowledge: Chronic Disease Management (1847) of the NOC, assessed using a five-point Likert scale, analyzed using descriptive statistics. Results: The mean of the result Knowledge: Chronic Disease Management (1847) was 3.56±1.42. The clinical index Procedures involved in treatment regimen had the highest mean 4.18±0.21, followed by Pain management strategies with 3.92±0.27. In the association between knowledge and healing, the best scores were in patients with at least one healed VU. Conclusion: The knowledge of the patients was moderate and it was necessary to promote educational actions according to individual demands.

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Reconstructing prehistoric languages

Philosophical Transactions of the Royal Society B Biological Sciences ◽

10.1098/rstb.2020.0187 ◽

2021 ◽

Vol 376 (1824) ◽

Author(s):

Antonio Benítez-Burraco ◽

Ljiljana Progovac

Keyword(s):

Human Evolution ◽

Language Evolution ◽

Theme Issue ◽

Brain Organization ◽

Functional Features

This theme issue builds on the surge of interest in the field of language evolution as part of the broader field of human evolution, gathering some of the field's most prominent experts in order to achieve a deeper, richer understanding of human prehistory and the nature of prehistoric languages. Taken together, the contributions to this issue begin to outline a profile of the structural and functional features of prehistoric languages, including the type of sounds, the nature of the earliest grammars, the characteristics of the earliest vocabularies and some preferred uses, like conversation and insult. By also correlating certain specific features of language with the changes in brain organization during prehistory, the contributions to this issue directly engage the genetic and the neuroscientific aspects of human evolution and cognition. This article is part of the theme issue ‘Reconstructing prehistoric languages'.

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Dementia With Lewy Bodies: the Principles of Diagnostics, Treatment, and Management

Medicina ◽

10.3390/medicina48010001 ◽

2012 ◽

Vol 48 (1) ◽

pp. 1 ◽

Cited By ~ 9

Author(s):

Jūratė Macijauskienė ◽

Vita Lesauskaitė

Keyword(s):

Dementia With Lewy Bodies ◽

Management Strategies ◽

Laboratory Data ◽

Lewy Bodies ◽

Corticobasal Degeneration ◽

Later Life ◽

Alpha Synuclein ◽

Diagnostic Features ◽

Protein Deposits ◽

Diagnosis Of Dementia

Dementia with Lewy bodies was first recognized as a separate entity about 30 years ago. The prevalence varies from 0% to 5% in the general population, and this disease accounts for 0% to 30.5% of all dementia cases. Dementia with Lewy bodies is considered the second most common cause of degenerative dementia after Alzheimer’s disease. The disease is characterized by alpha-synuclein immunoreactive protein deposits in both neurons and glial cells. The protein deposits are especially prominent in dopaminergic neurons, where they can be detected using conventional histological stains, such as hematoxylin and eosin, and are commonly referred to as Lewy bodies. The diagnosis of dementia with Lewy bodies is based on the presence of dementia as well as 2 of the following 3 core diagnostic features: 1) fluctuating cognition, 2) visual hallucinations, and 3) movement disorder. Diagnostic tests include laboratory data, structural and functional imaging, and electroencephalography. Differential diagnosis of dementia with Lewy bodies focuses on other later life dementia syndromes, other parkinsonian diseases (Parkinson’s disease, progressive supranuclear palsy, corticobasal degeneration), and primary psychiatric illnesses. There is type 1b evidence to support treatment with cholinesterase inhibitors. Glutamatergic and dopaminergic therapies are used as well. Standard neuroleptics are contraindicated, and atypical agents should be used cautiously. Nonpharmacologic measures – therapeutic environment, psychological and social support, physical activity, behavioral management strategies, caregivers’ education and support, and different services – could be suggested.

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Characterisation of the immune cells and cytokines involved in a model of atopic dermatitis

10.26686/wgtn.17067641 ◽

2021 ◽

Author(s):

◽

Karmella Naidoo

Keyword(s):

Atopic Dermatitis ◽

Wide Spectrum ◽

Management Strategies ◽

Substantial Reduction ◽

Skin Barrier ◽

Barrier Dysfunction ◽

Effector Cells ◽

Treatment And Prevention ◽

Inflammatory Parameters

<p>Atopic dermatitis (AD) is a highly debilitating disease with significant health impacts worldwide. It is a chronic and relapsing inflammatory skin disease which often poses a life-long burden for the affected individuals. AD has been a difficult disease to treat as it manifests with a wide spectrum of clinical phenotypes and the current clinical management strategies are non-specific. Therefore, it is imperative to identify specific immunological pathways that could be targeted to treat this disease. Previous studies have documented that AD disease progression is precipitated by a combination of skin barrier dysfunction, itch and immune dysregulation that are responsible for AD progression. However, the precise role of effector cells and cytokines have not been fully elucidated. To address this, I established a clinically relevant model of AD, using the vitamin D analogue, MC903. This MC903 model closely resembles the AD phenotype in patients, including inflammatory parameters, barrier dysfunction, itch, and histopathological characteristics, providing a novel platform to evaluate targets for the treatment and prevention of AD. Furthermore, this model exposed the cells and cytokines that are critically associated with disease severity, including eosinophils, mast cells, TSLP, IL-4 and IL-9, but not CD4+ T cells. The instrumental role of these effector cells and cytokines was established by their stepwise depletion or blockade. Indeed, functional eosinophil depletion via the use of inducible eosinophil (iPHIL) mice significantly ameliorated AD pathology, most notably itch. Similar results were obtained after blockade of the IL-4/IL-13 axis by genetic deletion of STAT6. The clinically more relevant use of soluble inhibitors targeting IL-9 and CRTh2 (in a prophylactic and therapeutic setting, respectively), both resulted in a substantial reduction in AD phenotype. In summary, this body of work led to the identification of key disease-initiating and effector cells and molecules that represent attractive targets for the treatment of AD.</p>

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Misoprostol Induced Hyperpyrexia associated with Seizures in Postpartum Parturient: Rare Side Effect and its Management in Critical Care Settings

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v7i1.5482 ◽

2021 ◽

Author(s):

Dheeraj Kapoor ◽

Manju Sharma ◽

Manpreet Singh ◽

Shraddha Sinha ◽

Binish Kathuria

Keyword(s):

Critical Care ◽

Side Effect ◽

Postpartum Haemorrhage ◽

Case Reports ◽

Management Strategies ◽

Delayed Presentation ◽

Treatment And Prevention ◽

Rare Side Effect ◽

Cost Efficient ◽

Line Drug

Misoprostol is a synthetic prostaglandin E1 analogue and has been reccommended as a safe, effective, easy to administer, cost efficient next in line drug after oxytocin, for the treatment and prevention of postpartum haemorrhage (PPH). Notwithstanding, it causes certain undesirable side effects compared to oxytocin such as nausea, vomiting, shivering, diarrhoea and transient fever. Transient pyrexia is commonly related with misoprostol administration, due to shift of hypothalamic set point. However, hyperpyrexia clubbed with seizures is a rare yet self-limiting side effect and requires prompt management strategies. There have been case reports describing fever following misoprostol administration but only few describing hyperpyrexia and even fewer describing with seizures. We report a case of hyperpyrexia associated with delayed presentation of generalised sezuires after administration of rectal misoprotol and its successful management in critical care settings.

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Mitochondria and the Pathophysiological Mechanism of Atrial Fibrillation

Current Pharmaceutical Design ◽

10.2174/1381612824666180903125300 ◽

2018 ◽

Vol 24 (26) ◽

pp. 3055-3061 ◽

Cited By ~ 6

Author(s):

Xinye Li ◽

Xinyu Yang ◽

Yanda Li ◽

Mengchen Yuan ◽

Chao Tian ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Anticancer Agents ◽

Treatment Options ◽

Management Strategies ◽

Pathophysiological Mechanism ◽

Treatment And Prevention ◽

Close Relationship ◽

Mitochondrial Distribution ◽

Transfer Chain

Atrial fibrillation (AF) is the most common and significant cardiac arrhythmia in clinical practice, however the pathophysiological mechanism of AF has not been fully explained. At present, there are no available treatment options that can target the underlying pathophysiological processes of AF. Research on improving management strategies for AF can start with a further understanding of the changes of cells in AF. Mitochondria play central roles in the function of cardiac myocytes and many of the pathophysiological processes implicated in AF are relative to mitochondrial function, including formation of reactive oxygen species (ROS), calcium homeostasis, and alterations of oxygen consumption. The changes of levels of phosphocreatine, electron transfer chain proteins and differences in mitochondrial distribution further imply that mitochondria play a role in AF. Related studies of recent years are summarized, in order to elucidate the causal relationship between mitochondria and AF, and provide potential therapeutic target for the treatment and prevention of AF in clinical practice. In the article, we summarize the direct or indirect factors that affect mitochondria function and thus cause AF, including anticancer agents, surgery, gene, age, air pollution, oxidative stress, and β3-adrenoceptor (β3-AR). There is a close relationship between mitochondrial dysfunction and the occurrence of AF, which cannot be ignored, and further research in this area is needed.

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Autopsy validation of 123I-FP-CIT dopaminergic neuroimaging for the diagnosis of DLB

Neurology ◽

10.1212/wnl.0000000000003512 ◽

2016 ◽

Vol 88 (3) ◽

pp. 276-283 ◽

Cited By ~ 65

Author(s):

Alan J. Thomas ◽

Johannes Attems ◽

Sean J. Colloby ◽

John T. O'Brien ◽

Ian McKeith ◽

...

Keyword(s):

Brain Tissue ◽

Clinical Diagnosis ◽

Lewy Body ◽

Lewy Bodies ◽

Lewy Body Disease ◽

High Specificity ◽

Clinical Diagnoses ◽

Diagnosis Of Dementia ◽

Autopsy Diagnosis

Objective:To conduct a validation study of 123I-N-fluoropropyl-2b-carbomethoxy-3b-(4-iodophenyl) nortropane (123I-FP-CIT) SPECT dopaminergic imaging in the clinical diagnosis of dementia with Lewy bodies (DLB) with autopsy as the gold standard.Methods:Patients >60 years of age with dementia who had undergone 123I-FP-CIT imaging in research studies and who had donated their brain tissue to the Newcastle Brain Tissue Resource were included. All had structured clinical research assessments, and clinical diagnoses were applied by consensus panels using international diagnostic criteria. All underwent 123I-FP-CIT imaging at baseline, and scans were rated as normal or abnormal by blinded raters. Patients were reviewed in prospective studies and after death underwent detailed autopsy assessment, and neuropathologic diagnoses were applied with the use of standard international criteria.Results:Fifty-five patients (33 with DLB and 22 with Alzheimer disease) were included. Against autopsy diagnosis, 123I-FP-CIT had a balanced diagnostic accuracy of 86% (sensitivity 80%, specificity 92%) compared with clinical diagnosis, which had an accuracy of 79% (sensitivity 87%, specificity 72%). Among patients with DLB, 10% (3 patients) met pathologic criteria for Lewy body disease but had normal 123I-FP-CIT imaging.Conclusions:This large autopsy analysis of 123I-FP-CIT imaging in dementia demonstrates that it is a valid and accurate biomarker for DLB, and the high specificity compared with clinical diagnosis (20% higher) is clinically important. The results need to be replicated with patients recruited from a wider range of settings, including movement disorder clinics and general practice. While an abnormal 123I-FP-CIT scan strongly supports Lewy body disease, a normal scan does not exclude DLB with minimal brainstem involvement.Classification of evidence:This study provides Class I evidence that 123I-FP-CIT dopaminergic neuroimaging accurately identifies patients with DLB.

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Dementia and frailty

Oxford Handbook of Palliative Care ◽

10.1093/med/9780198745655.003.0020 ◽

2019 ◽

pp. 579-618

Keyword(s):

Palliative Care ◽

Hospital Admissions ◽

Advanced Disease ◽

Psychological Symptoms ◽

Management Strategies ◽

People With Dementia ◽

Diagnosis Of Dementia ◽

The Uk ◽

End Stage

This chapter outlines the symptoms, epidemiology, aetiology, and differential diagnosis of dementia, with emphasis on advanced disease. It discusses the role of dementia treatments, the challenges faced with advanced disease, and guides to recognition and treatment of common symptoms, including behavioural and psychological symptoms of dementia and pain. The chapter also discusses pharmacological and non-pharmacological approaches to management of dementia symptoms, highlighting the role of palliative care, when it is appropriate to refer, and terminal care. The chapter illustrates some of the controversial aspects of care. At the current rate there will be 850,000 people with dementia in the UK by 2015, and this number is forecast to increase to over 1 million by 2025 and over 2 million by 2051.This is contributing to one in four hospital admissions, with the health and social costs of dementia estimated to be more than stroke, heart disease, and cancer combined. Along with these worrying progressive epidemiological figures, we need to take into account the immense caring burden for families, carers, and society. End-stage dementia often falls between the cracks of specialization, with professionals feeling under-prepared for the intricacies of end-stage dementia management strategies. Palliative care has been slow in its involvement for multiple reasons, but primarily because dementia has a much slower disease trajectory than cancer, with an unclear prognosis.

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Cardiovascular Calcification in Chronic Kidney Disease—Therapeutic Opportunities

Toxins ◽

10.3390/toxins12030181 ◽

2020 ◽

Vol 12 (3) ◽

pp. 181 ◽

Cited By ~ 1

Author(s):

Anika Himmelsbach ◽

Carina Ciliox ◽

Claudia Goettsch

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Imaging Techniques ◽

Management Strategies ◽

Clinical Manifestations ◽

Therapeutic Interventions ◽

Rodent Models ◽

Treatment And Prevention ◽

Resolution Imaging ◽

Meta Analyses

Patients with chronic kidney disease (CKD) are highly susceptible to cardiovascular (CV) complications, thus suffering from clinical manifestations such as heart failure and stroke. CV calcification greatly contributes to the increased CV risk in CKD patients. However, no clinically viable therapies towards treatment and prevention of CV calcification or early biomarkers have been approved to date, which is largely attributed to the asymptomatic progression of calcification and the dearth of high-resolution imaging techniques to detect early calcification prior to the ‘point of no return’. Clearly, new intervention and management strategies are essential to reduce CV risk factors in CKD patients. In experimental rodent models, novel promising therapeutic interventions demonstrate decreased CKD-induced calcification and prevent CV complications. Potential diagnostic markers such as the serum T50 assay, which demonstrates an association of serum calcification propensity with all-cause mortality and CV death in CKD patients, have been developed. This review provides an overview of the latest observations and evaluates the potential of these new interventions in relation to CV calcification in CKD patients. To this end, potential therapeutics have been analyzed, and their properties compared via experimental rodent models, human clinical trials, and meta-analyses.

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Long-Term Station Blackout Accident Analyses of a PWR with RELAP5/MOD3.3

Science and Technology of Nuclear Installations ◽

10.1155/2013/851987 ◽

2013 ◽

Vol 2013 ◽

pp. 1-15 ◽

Cited By ~ 10

Author(s):

Andrej Prošek ◽

Leon Cizelj

Keyword(s):

Management Strategies ◽

Severe Accident ◽

Stress Tests ◽

Pressurized Water ◽

Makeup Water ◽

Reactor Coolant ◽

The Core ◽

Station Blackout ◽

Accident Sequences

Stress tests performed in Europe after accident at Fukushima Daiichi also required evaluation of the consequences of loss of safety functions due to station blackout (SBO). Long-term SBO in a pressurized water reactor (PWR) leads to severe accident sequences, assuming that existing plant means (systems, equipment, and procedures) are used for accident mitigation. Therefore the main objective was to study the accident management strategies for SBO scenarios (with different reactor coolant pumps (RCPs) leaks assumed) to delay the time before core uncovers and significantly heats up. The most important strategies assumed were primary side depressurization and additional makeup water to reactor coolant system (RCS). For simulations of long term SBO scenarios, including early stages of severe accident sequences, the best estimate RELAP5/MOD3.3 and the verified input model of Krško two-loop PWR were used. The results suggest that for the expected magnitude of RCPs seal leak, the core uncovery during the first seven days could be prevented by using the turbine-driven auxiliary feedwater pump and manually depressurizing the RCS through the secondary side. For larger RCPs seal leaks, in general this is not the case. Nevertheless, the core uncovery can be significantly delayed by increasing RCS depressurization.

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