Abstract 248: Baseline Cognitive Impairment a Predictor of Mortality in Cardiovascular Disease

2012 ◽  
Vol 111 (suppl_1) ◽  
Author(s):  
Antonio D Lassaletta ◽  
Frank W Sellke ◽  
Ronald A Cohen
Keyword(s):  
Cardiovascular Disease ◽  
Executive Function ◽  
Cognitive Function ◽  
Cognitive Dysfunction ◽  
Independent Living ◽  
Cognitive Domains ◽  
The Relationship

Objective: Few longitudinal studies have examined outcomes of patients with cardiovascular disease (CVD) in relation to earlier, baseline cognitive function, or examined the relationship between specific cognitive domains and mortality. This study attempted to clarify the relationship between cognitive function and long-term outcomes, particularly mortality, in patients with cardiovascular disease. Methods: One hundred seventy seven participants between 55 and 85 years of age with an established history CVD were recruited from healthcare institutions. A comprehensive neurophysiological test battery was administered to all patients at baseline assessing 4 cognitive domains: language, visual-spatial, memory, and attention-executive function. Composite scores were calculated by averaging z-scores of all component measures. At 6-year the follow-up, of the 136 patients who were still enrolled, the 116 who were still alive were contacted by phone for assessment of level of independent living, and subjective assessment of cognitive function, and quality of life.Results were corrected for age. Results: At follow-up, participants who were deceased had significantly lower baseline attention-executive function (M=-0.51, SD=0.78 vs. M=0.06, SD=0.54 in survivors, p < 0.01). Poorer memory performance at baseline was associated with a greater degree of cognitive dysfunction at follow-up (p = 0.085). No significant relationships were found between baseline cognitive performance and independent living status or quality of life. Conclusion: Impaired executive function was predictive of poorer outcomes, specifically, 6-year mortality. This finding reinforces the frontal nature of vascular cognitive impairments, especially in regard to the long term sequelae of cognitive dysfunction in patients with CVD. The higher mortality observed in patients with baseline executive domain impairment may be due to behaviors such as impaired self-care, treatment adherence and rehab participation or functional impairments that exacerbate health problems, resulting in death. Patients with cardiovascular disease and executive function impairment should be identified and measures taken to address these potential problems.

scholarly journals HGG-47. DECREASED GROWTH VELOCITY WITH LONG TERM USE OF BRAFV600e AND MEK INHIBITION IN A PATIENT WITH ANAPLASTIC GANGLIOGLIOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii352-iii352
Author(s):  
Hung Tran ◽  
Robert Cooper
Keyword(s):  
Growth Velocity ◽  
Direct Result ◽  
Chromosomal Microarray ◽  
Mek Inhibition ◽  
Follow Up Study ◽  
The Family ◽  
The Relationship

Abstract PURPOSE To describe decreased growth velocity with long term use of BRAFV600e and MEK inhibition in a patient with anaplastic ganglioglioma. RESULTS 4-year-old patient was found to have a 6 x 4.6 x 5 cm mass in the hypothalamus. Pathology consistent with anaplastic ganglioglioma and chromosomal microarray revealed a BRAFV600e mutation. Patient started on dabrafenib and trametinib and tumor decreased 85% after 3 months. She is stable without significant toxicities 39 months on therapy, and is now 8 years old. Patient had been growing at the 25% for weight and 12% for height but is now 65% for weight and 0.5% for height. It is difficult to tease out the relationship between the tumor, the location of the tumor, and the BRAF and MEK inhibitors and their effect on growth. Discussions with the family and endocrinology are ongoing but being &lt;1% for height will lead to decrease in quality of life. CONCLUSIONS Further follow-up study is needed to determine if this is truly a long-term toxicity, or if this may just be a direct result of the location of the tumor. Would supplementation with growth hormone in this patient lead to losing control of a high grade tumor, or would it simply replace a hormone that is not produced?

scholarly journals Health-related quality of life of COVID-19 survivors at 6 months after hospital discharge: a cohort study

2021 ◽  
Author(s):  
MeiXuan Lin ◽  
Liqun Huang ◽  
Danwen Zheng ◽  
Linjie Zhang ◽  
Bing Feng ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Cognitive Function ◽  
Health Related Quality ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related

Abstract Background: COVID-19 is a multi-systemic disease that is highly contagious and pathogenic. The long-term consequences of it are not yet clear, as is whether society and life can return to a healthy state. Long-term assessment of their health-related quality of life (HRQoL) is essential. This study aimed to investigate HRQoL and its risk factors in COVID-19 survivors at a follow-up of 6-month. Methods: A multicenter cross-sectional survey was conducted among 192 COVID-19 patients with confirmed age ≥ 18 years who were discharged from various hospitals in Wuhan from January to April 2020. The demographic characteristics, clinical characteristics, and laboratory results of the study subjects were obtained from the hospital's medical records. Survivors' HRQoL was assessed using the Short Form 36 (SF-36), cognition was assessed using the ascertain dementia eight-item informant questionnaire (AD8), and survivors' pulmonary function were examined. All participants in this study completed the survey and testing at Hubei Provincial Hospital of Chinese and Western Medicine. SF-36 scores were compared with the Chinese norm, and logistic regression and multivariate analysis were used to investigate the factors affecting HRQoL in COVID-19 survivors. Results: SF-36 showed significant differences in HRQoL between COVID-19 survivors and the general Chinese population ( P< 0.05).Multiple linear regression demonstrated that age was negatively correlated with physical functioning (PF), role-physical limitation (RP) and social functioning (SF) ( P <0.05). Bodily pain (BP), vitality (VT), SF and role-emotional limitation (RE) were negatively correlated with females ( P <0.05). Length from discharge to follow‐up was positively correlated with PF and RP ( P <0.05). Abnormal cognitive function was negatively correlated with PF, RP, general health (GH), VT, SF, RE and mental health (MH) ( P <0.05). Abnormal Carbon Monoxide Diffusing Capacity (DLCO%<80%) was significantly negatively correlated with PF and SF ( P <0.05).In addition, there was a significant negative correlation between Coronary heart disease and RP, GH, VT and RE ( P <0.05).Logistic regression analysis demonstrated that age(OR 1.032) and AD8 scores (OR 1.203)were risk factors associated with a low physical component summary (PCS) score. Length from discharge to follow‐up (OR 0.971) was the protective factor for PCS score. Abnormal cognitive function (OR 1.543) was a significant determinant associated with a mental component summary (MCS)<50 in COVID-19 patients. Conclusions: The HRQoL of COVID-19 survivors remains to be improved at six-month follow-up. Future studies should track HRQoL in older adults, women, patients with abnormal DLCO, and abnormal cognitive function for a long time and provide them with rehabilitation advice and guidance.

Case Studies of Postoperative Cognitive Dysfunction in Elderly Patients

2021 ◽  
pp. 1-5
Author(s):  
Kalliopi Megari ◽  
Kalliopi Megari
Keyword(s):  
Quality Of Life ◽  
Elderly Patients ◽  
Cognitive Dysfunction ◽  
Critical Role ◽  
Postoperative Cognitive Dysfunction ◽  
Verbal Working Memory ◽  
Short Term

Background and Objective: Postoperative cognitive dysfunction (POCD) involves decline in several cognitive domains after surgery and is particularly common after cardiac surgery. Given the potential effects of such cognitive dysfunction on quality of life, it is important to study it in multiple populations in order to limit its occurrence. Recent advances in surgical technology may assist in achieving this goal. Methods: We present the long-term neuropsychological outcome of two elderly patients, one of whom had off pump heart surgery and the other oncological surgery. We administered a series of neuropsychological tests assessing attention, complex scanning, verbal working memory, executive functioning, short-term and long-term memory, and visuospatial perception before surgery, prior to discharge, at 3-month follow-up and 6 years after surgery. We compared the performance of these two patients to normative datasets. Results: Despite equivalent levels of pre-surgery performance between the two patients, the oncology patient exceeded his preoperative neurocognitive levels, suggesting less postoperative cognitive dysfunction in the heart patient overall, on all neuropsychological domains at 6-year follow-up, except short-term retention. In contrast, the heart patient showed no improvement, and, instead, showed some cognitive decline which remained consistent over time. Conclusion: Our findings highlight the critical role of the type of surgery utilized in the development of POCD and have implications for clinical management and patients’ quality of life in the very long term.

scholarly journals Life Outcomes of Anterior Temporal Lobectomy

Neurosurgery ◽  
2013 ◽  
Vol 73 (6) ◽  
pp. 1018-1025 ◽  
Author(s):  
Jana E. Jones ◽  
Jacquelyn B. Blocher ◽  
Daren C. Jackson
Keyword(s):  
Quality Of Life ◽  
Independent Living ◽  
Temporal Lobectomy ◽  
Life Outcomes ◽  
Financial Independence ◽  
Anterior Temporal Lobectomy ◽  
Time Points

Abstract BACKGROUND: At 3 time points, this study examined long-term psychosocial life outcomes of individuals who underwent anterior temporal lobectomy in comparison with individuals with temporal lobe epilepsy who were medically managed. OBJECTIVE: To examine seizure frequency, employment, driving, independent living, financial independence, mental health, and quality of life at each follow-up assessment, as well as predictors of outcomes. METHODS: All participants were diagnosed with medically intractable complex partial seizures of temporal lobe origin with or without secondary generalization. A structured clinical interview was used at all 3 time points. Information was obtained regarding seizure frequency, antiepilepsy medications, employment, driving status, financial assistance, and independent living. Additionally, questions regarding quality of life, satisfaction with surgery, and the presence of depression or anxiety were included. Participants were, on average, 17 years postsurgery. RESULTS: Surgery resulted in significantly improved and sustained seizure outcomes. At the first, second, and third follow-ups, 67%, 72%, and 67% of participants in the surgery group remained seizure-free in the year before the follow-up interview. At each follow-up, 97%, 84%, and 84% reported that they would undergo surgery again. Seizure freedom predicted driving outcomes at all 3 time points, but was not a significant predictor for employment, independent living, or financial independence. Psychosocial life outcomes in the surgical group were improved and maintained over time in comparison with the medically managed group. CONCLUSION: This systematic long-term investigation provides strong support for the positive impact of anterior temporal lobectomy on psychosocial life outcomes including driving, employment, independent living, and financial independence.

Postoperative Cognitive Dysfunction

2018 ◽  
pp. 449-454
Author(s):  
Wael Saasouh ◽  
Shobana Rajan
Keyword(s):  
Cognitive Function ◽  
Early Detection ◽  
Cognitive Dysfunction ◽  
Surgical Procedure ◽  
Postoperative Cognitive Dysfunction ◽  
Short Term ◽  
Related Cost ◽  
Postoperative Setting

Postoperative cognitive dysfunction (POCD) is an underdiagnosed serious complication occurring after a surgical procedure. It carries risks for short-term and long-term complications and may predispose an individual to a multitude of morbidities, increased healthcare-related cost, as well as death. Prevention of POCD is the most important step in avoiding morbidity, and steps to minimize its effect include early detection, proper management, and diligent follow-up. This chapter discusses, among other issues, measurement and examination of POCD, cognitive function in the preoperative and postoperative setting, intraoperative factors that influence POCD, complications of POCD, and strategies to protect patients against POCD.

Effect of immunotherapy and stereotactic radiosurgery on cognitive function and quality of life in long term survivors of metastatic brain malignancies.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 125-125
Author(s):  
Naveen Kumar Reddy ◽  
Franklin Brown ◽  
Judith Hess ◽  
Miklos C. Fogarasi ◽  
Veronica Chiang
Keyword(s):  
Quality Of Life ◽  
Executive Function ◽  
Cognitive Function ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Processing Speed ◽  
Whole Brain Radiation ◽  
Brain Radiation

125 Background: Use of whole brain radiation, radiosurgery, targeted therapies, and more recently, immunotherapies have resulted in improved survival for patients with brain metastases. As patients live longer, it is becoming increasingly important to understand the long-term cognitive function (CF) and quality of life (QOL) changes associated with these therapies. Methods: The Yale Gamma Knife Database was searched for patients surviving greater than 2 years after brain metastasis diagnosis. Of 79 patients identified, 19 were willing to participate in study. All participants underwent a single assessment session of cognitive tests that evaluated executive function (TMTa and TMTb), processing speed (COWA), memory (HVLT), and quality of life (FACT-Br). Results: Within the whole group, mean age was 65.5 years (range 50-88), median time from brain metastasis diagnosis to testing was 60 months (range 25.6-120.6). Mean number of lesions treated was 3.8 (range 1-10). Mean total lesion volume treated was 14.1 mm3 (range 0.6 - 39). Only 2 patients were treated with whole brain radiation therapy. Patient scores were compared to validated normative data for their age group. Patients performed worse than normal for their age on TMTb (p < 0.0001), total word recall (p < 0.0001) and discriminative ability (p = 0.0004). Patients performed as expected for age on TMTa, animal naming, FAS, and % retention. A negative correlation was seen between executive function results and QOL (TMTa: r = -0.569, p ≤ 0.05, TMTb: r = -0.484, p ≤ 0.05) and a positive correlation was seen between processing speed results and QOL (r = 0.672, p ≤ 0.001). Conclusions: In patients surviving more than 2 years after diagnosis and successful treatment of brain metastases, this study shows that portions of executive function and memory are worse than expected for their age, while cognitive processing speed is similar to norms. Cognitive function was correlated with QOL; patients with lowered cognitive function reported a lower quality of life. Given this preliminary data, a further study in a larger population is needed to determine if certain treatments preferentially predispose patients to declines in CF and QOL.

Blood TDP-43 Combined with Demographics Information Predicts Dementia Occurrence in Community Non-Dementia Elderly

2021 ◽  
Vol 79 (1) ◽  
pp. 301-309
Author(s):  
Lin Sun ◽  
Wei Li ◽  
Ling Yue ◽  
Shifu Xiao
Keyword(s):  
Cognitive Function ◽  
Dna Binding Protein ◽  
Blood Levels ◽  
Neurofilament Light Chain ◽  
Neurofilament Light ◽  
Dementia Patients ◽  
Relationship Of ◽  
The Relationship

Background: TAR DNA-binding protein-43 (TDP-43) and neurofilament light chain (NfL) are promising fluid biomarkers of disease progression for various dementia. Objective: We would explore whether blood levels of NfL and TDP-43 could predict the long-term progression to dementia, and the relationship of TDP-43 levels between cerebrospinal fluid (CSF) and blood. Methods: A total of 86 non-dementia elderly received 7-year follow-up, and were divided into 49 stable normal control (NC)/mild cognitive impairment (MCI) subjects, 19 subjects progressing from NC to MCI, and 18 subjects progressing from NC/MCI to dementia. Blood TDP-43 and NfL levels, and cognitive functions were measured in all subjects. Furthermore, another cohort of 23 dementia patients, including 13 AD and 10 non-AD patients received blood and CSF measurements of TDP-43. Results: In cohort 1, compared to stable NC/MCI group, there were higher levels of blood TDP-43 at baseline in subjects progressing from NC/MCI to dementia. The combination of baseline blood TDP-43 levels with demographics including age, education, and diabetes had the detection for dementia occurrence. Baseline blood levels of NfL are negatively associated with cognitive function at 7-year follow-up. In cohort 2, we found there were no relationship between CSF and blood levels of TDP-43. Moreover, the levels of TDP-43 in CSF was positively associated with the age of patients, especially in AD group. Conclusion: Single blood TDP-43 could not estimate dementia occurrence; however, TDP-43 combined with demographics has the predictive effect for dementia occurrence and NfL level is associated with a decrease of cognitive function.

scholarly journals PSYCHOLOGICAL WELL-BEING AND CHANGE OF COGNITIVE FUNCTION OVER 4 YEARS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S814-S814
Author(s):  
Dexia Kong ◽  
Dexia Kong ◽  
XinQi Dong
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Function ◽  
Well Being ◽  
Rate Of Change ◽  
Psychological Well Being ◽  
Chinese Older Adults ◽  
Cognitive Domains ◽  
Individual Cognition ◽  
The Relationship

Abstract This study aims to examine the relationship between psychological-wellbeing (including depressive symptoms, loneliness, anxiety, hopelessness, and stress) and cognitive function during a 4-year period among U.S. Chinese older adults. Data were from 2,300 PINE participants who completed in-home interviews at baseline, 2-year and 4-year follow-up. Cognitive function was assessed by five individual cognition tests at baseline and follow-up interviews. Mixed-effects regression models were conducted. A trend of decline in global cognition and multiple cognitive domains was observed. The study findings showed that depressive symptoms (Estimate= -0.03, p&lt;0.001), anxiety (Estimate = -0.02, p&lt;0.001), hopelessness (Estimate = -0.01, p&lt;0.01), and stress (Estimate = -0.01, p&lt;0.001) were associated with poorer global cognitive function at baseline. Baseline psychological well-being was not associated with changes in cognitive function during a 4-year period. Significant predictors of rate of change in cognitive function will be discussed. Potential explanations and implications of these findings will be presented.

scholarly journals MON-636 The Relationship Between Glucose Control & Cognitive Function in People with Diabetes After a Lacunar Stroke

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Tali Cukierman-Yaffe ◽  
Leslie McClure ◽  
Thomas Risoli ◽  
Jackie Bosch ◽  
Hertzel C Gerstein ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Function ◽  
Cognitive Dysfunction ◽  
Glucose Control ◽  
High Risk Population ◽  
Z Score ◽  
Lacunar Stroke ◽  
The Relationship ◽  
Over Time

Abstract Background & Objective Both lacunar strokes and diabetes are risk factors for dementia and cognitive dysfunction. Thus, elucidating modifiable risk factors for cognitive dysfunction in people with type 2 diabetes who experienced a lacunar infarct has large public health implications. One such factor may be glycemic status, as measured by glycosylated hemoglobin (A1C). Thus, the aim of this study was to assess the relationship between A1C and cognitive function in people with diabetes after a lacunar stroke. Research Design & Methods The effect of baseline and follow-up A1C on the baseline and the change in Cognitive Assessment Screening Instrument (CASI) score over time among participants with a median of 2 cognitive assessments (range 1-5) was examined in of 942 individuals with diabetes and a lacunar stroke who participated in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (ClinicalTrials.gov number, NCT00059306). Results Every 1 % higher baseline A1C was associated with a 0.06 lower standardized CASI z-score (95% CI -0.101, -0.018). Higher baseline A1C values were associated with lower CASI z-score over time (p for interaction=0.037). A 1% increase in A1C over time, corresponded with a CASI score decrease of 0.021 (95% CI -0.0043, -0.038) during follow-up. All these remained statistically significant after adjustment for age, sex, education, race, depression, hypertension, hyperlipidemia, BMI, CVD, OSA, diabetic retinopathy, nephropathy insulin use and White Matter Abnormalities. Conclusion This analysis of 942 individuals with diabetes after a lacunar stroke demonstrates a relationship between A1C and change in cognitive scores over time. Intervention studies are needed in order to delineate if better glucose control could slow the rate of cognitive decline in this high risk population.

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