scholarly journals Characteristics of Bipolar Patients with Cognitive Impairment of Suspected Neurodegenerative Origin: A Multicenter Cohort

2021 ◽  
Vol 11 (11) ◽  
pp. 1183
Author(s):  
Esteban Munoz Musat ◽  
Emeline Marlinge ◽  
Mélanie Leroy ◽  
Emilie Olié ◽  
Eloi Magnin ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
High Frequency ◽  
Executive Dysfunction ◽  
Cognitive Improvement ◽  
Increased Risk ◽  
Csf Biomarker ◽  
The Mean ◽  
Bipolar Patients ◽  
Biomarker Signature ◽  
Retrospective Multicenter Study

Bipolar disorder is associated with an increased risk of dementia with aging. Little is known regarding this association, limiting appropriate diagnosis and management. We aimed to describe the characteristics of bipolar patients with late cognitive impairment for whom the hypothesis of an underlying neurodegenerative disease had been raised. We performed a retrospective multicenter study, recruiting bipolar patients over 50 years old from five French tertiary memory centers who had undergone cerebrospinal fluid (CSF) biomarker assessment for Alzheimer’s disease (AD). Clinical, neuropsychological, and paraclinical characteristics were analyzed and 78 patients were included. The mean age at the onset of cognitive impairment was 62.4 years (±9.2). The mean MMSE score was 22.8 (±4.5), the mean FAB was 11.7 (±3.9), and the mean FCRST was 15.8 (±7.4)/36.8 (±9.7) (free/total recall). A total of 48.6% of the patients displayed cognitive fluctuations, and 38.2% showed cognitive improvement during follow-ups; and 56.3% of the patients showed Parkinsonism, of which 12.7% had never received antipsychotics. Among patients who underwent DAT-scans, 35.3% displayed dopaminergic denervation; 10.3% of patients had CSF AD biological signature (“A+ T+” profile), while 56.4% had other abnormal CSF profiles. Thus, clinical presentation was dominated by executive dysfunction, episodic memory impairment, fluctuating cognition, and a high frequency of Parkinsonism. Specifically, high frequency of delusional episodes suggests limited tolerance of psychotropic drugs. Most patients had abnormal CSF biomarker profiles, but only a minority displayed AD’s specific biomarker signature. Therefore, while our results unveil shared common neurocognitive features in bipolar patients with cognitive impairment of suspected neurodegenerative origin they suggest a participation of various underlying pathologies rather than a common degenerative mechanism in the pathophysiology of this condition.

A pilot study examining the profile of older people on clozapine

2018 ◽  
Vol 26 (6) ◽  
pp. 619-623
Author(s):  
Jen Benbow ◽  
Anne PF Wand ◽  
Brett Simpson
Keyword(s):  
Cognitive Impairment ◽  
Side Effects ◽  
Older People ◽  
Social History ◽  
Geriatric Medicine ◽  
Executive Dysfunction ◽  
Screening Tools ◽  
The Mean ◽  
Considerable Morbidity ◽  
And Function

Objective: The primary aim was to comprehensively describe the characteristics of a cohort of older people taking clozapine. Method: Participants aged ⩾ 60 had a geriatric assessment including full medical, medication and social history. Standardized screening tools for cognition, function, comorbidity and antipsychotic side effects were administered and descriptive statistics utilized. Results: Thirteen patients were eligible to participate and 10 were assessed. The mean age was 69 years. The mean clozapine dose was 309 mg/day and mean duration of use was 10 years. All participants had executive dysfunction, and half had cognitive impairment. The mean number of co-morbid conditions was five. Seven people met the criteria for polypharmacy. Eight people experienced moderate–severe antipsychotic-related side-effects. The majority demonstrated impaired physical functioning. Conclusions: This cohort of older people taking clozapine experienced considerable morbidity, functional and cognitive impairment. We suggest routine screening of cognition and function in clozapine patients aged ⩾ 60 years. Those screening positive should be considered for further assessment by Older Person’s Mental Health Services and/or a Geriatric Medicine service.

Treatment of Cognitive Impairment and the Role of Demographic Factors in Disease Progression: The Final Results of the Russian Observational Program “DIAMANT”

2020 ◽  
pp. 1-11
Author(s):  
Vladimir Anatolyevich Parfenov ◽  
Sergey Anatolyevich Zhivolupov ◽  
Irina Evgenyevna Poverennova ◽  
Marina Valentinovna Nesterova ◽  
Svetlana Evgenyevna Ushakova ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Socioeconomic Factors ◽  
Age Groups ◽  
Post Treatment ◽  
Wilcoxon Test ◽  
Cognitive Improvement ◽  
Number Of Patients ◽  
The Mean ◽  
Moca Score

<b><i>Background:</i></b> Chronic cerebral ischemia (CCI) is a form of cerebrovascular disease manifested as a vascular cognitive impairment (VCI). The management of the patients with CCI is determined by a healthy lifestyle and early therapy aimed at correcting and preventing this disease. Divaza is a drug with endothelial protective and nootropic effects. We present the final efficacy and safety analysis of all-Russian, open-label, prospective, observational, multicenter study of Divaza and emphasize the role of demographic and socioeconomic factors in cognitive disorder (CD) progression. <b><i>Methods:</i></b> CCI patients (<i>n</i> = 2,583) with or without CD were enrolled. Patients received Divaza (2 tablets 3 times per day for 12 weeks). Montreal Cognitive Assessment (MoCA) testing was required. The change in the mean MoCA score post-treatment was used as the primary endpoint. As the secondary endpoints, the number of patients with a MoCA &#x3c;26 and ≤17 (dementia); the percentage of patients with a MoCA score improvement in different age groups; the dynamics of mean MoCA score in age groups; and the relationship between CD and sex or regional social/economic factors were assessed. <b><i>Results:</i></b> Divaza therapy led to a significant improvement: the mean MoCA score was up to 20% higher post-treatment (Wilcoxon test, <i>p</i> &#x3c; 0.0001 vs. baseline). The number of participants with MoCA ≥26 increased by 33.6%. The number of patients with dementia was 4.1 times less after therapy (<i>p</i> &#x3c; 0.00001 vs. baseline). Divaza improved cognitive functions of patients in each age group. Findings demonstrate that regional socioeconomic factors contribute to CD development and severity. The observed divergence between sexes was a result of a larger number of women enrolled. The study confirmed the safety of Divaza. <b><i>Conclusions:</i></b> In the study, we observed the efficacy of Divaza for the treatment of CD: a therapy contributed to an increase in the mean MoCA score and the positive dynamics in the number of patients with cognitive improvement.

scholarly journals Comparative evaluation of levetiracetam and valproic acid as monotherapy on cognitive impairment in patients of epilepsy

2019 ◽  
Vol 8 (4) ◽  
pp. 674
Author(s):  
Shreshth Khanna ◽  
Suman Bala ◽  
Yashpal Singh ◽  
Taruna Sharma ◽  
Juhi Kalra ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
P Value ◽  
Cognitive Improvement ◽  
Institutional Ethics ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
The Impact

Background: Cognitive decline with AEDs (Anti-epileptic drugs) is associated with learning and memory deficits especially in the younger age group. The data regarding the impact of levetiracetam and valproic acid as monotherapy on cognition in epileptic patients is scarce. The present study was done for evaluation of cognitive decline associated with the use of AEDs.Methods: Present study was a prospective study on 60 patients on AEDs for a period of 12 weeks. Patients were enrolled from the Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India and divided into group A (levetiracetam) and group B (valproic acid) with 30 patients in each group. Permission from the institutional ethics committee and written informed consent was taken from all the patients. They were analyzed for cognitive impairment using MMSE and MoCA scales at baseline and 12 weeks.Results: The mean duration of disease was 2.13±1.1 years and 2.08±1.1 years and mean age of the patients was 14.67±1.9 years in group A and 16.20±1.6 years in group B. GTCS was present in 31 patients (52%) followed by partial seizures in 29 patients (48%). The mean change in the MMSE scores from baseline to 12 weeks was significant in group A 1.30±1.1 (p value <0.05) and change group B was -0.20±1.4 not statistically significant. The mean change was observed in MoCA scores from baseline to 12 weeks was significant in both groups A and B by 1.17±1.1 and -0.70±1.1 respectively (P value <0.05).Conclusions: Patients on levetiracetam showed cognitive improvement, whereas patients on valproic acid showed a decline in the MMSE and MoCA scores.

Abstract WP427: Cognitive Function of Ten-year Stroke Survivors Compared to Non-stroke Individuals: the Lund Stroke Register

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hossein Delavaran ◽  
Ann-Cathrin Jönsson ◽  
Håkan Lövkvist ◽  
Susanne Iwarsson ◽  
Sölve Elmståhl ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Executive Dysfunction ◽  
Screening Methods ◽  
Stroke Survivors ◽  
Cognitive Screening ◽  
Severe Cognitive Impairment ◽  
Post Stroke ◽  
Increased Risk

Introduction: Post-stroke cognitive impairment (PSCI) has a considerable impact on patients and society. However, the characteristics and prevalence of long-term PSCI may be influenced by assessment methods and selection bias. We therefore used two cognitive screening methods to assess PSCI in ten-year stroke survivors, made comparisons with non-stroke individuals, and compared these screening methods. Methods: The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered and compared in a population-based consecutive sample of ten-year stroke survivors. In addition, age- and sex-matched non-stroke controls were assessed with the MMSE. Regression analyses adjusting for education compared the stroke survivors’ MMSE performance with the controls. Moderate/severe cognitive impairment, approximating to dementia, was defined using MMSE<24 and MoCA<20 as cut-offs. To detect those with mild cognitive impairment, alternative cut-offs of MMSE<27 and MoCA<25 were also used. Results: In total, 127 of 145 stroke survivors participated. The total MMSE-scores were similar for stroke survivors (median 27) and 354 controls (median 27; p =0.922); as well as proportions with MMSE<24 (23% vs. 17%; p =0.175) or MMSE<27 (47% vs. 49%; p =0.671). After adjustment for education, stroke survivors showed an increased risk for moderate/severe cognitive impairment defined by MMSE<24 (OR=1.82; p =0.036). Executive dysfunction was seen in 42% of the stroke survivors vs. 16% of the controls as evaluated by MMSE ( p <0.001). According to MoCA, moderate/severe cognitive impairment (MoCA<20) was observed in 28% of the stroke survivors; any degree of cognitive impairment (MoCA<25) was seen in 61%; and 45-61% displayed executive function deficits. Conclusions: PSCI including executive dysfunction is common among ten-year stroke survivors, who have an increased risk of moderate/severe cognitive impairment compared to non-stroke controls. The prevalence of long-term PSCI may have been previously underestimated, and MoCA may be more suitable for post-stroke cognitive assessment.

scholarly journals Soluble TREM2 is elevated in Parkinson’s disease subgroups with increased CSF tau

Brain ◽  
2020 ◽  
Vol 143 (3) ◽  
pp. 932-943 ◽  
Author(s):  
Edward N Wilson ◽  
Michelle S Swarovski ◽  
Patricia Linortner ◽  
Marian Shahid ◽  
Abigail J Zuckerman ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Parkinson’S Disease ◽  
Alzheimer's Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Amyloid Β ◽  
Soluble Form ◽  
Elderly Subjects ◽  
Csf Biomarker ◽  
Biomarker Signature

Abstract Parkinson’s disease is the second most common neurodegenerative disease after Alzheimer’s disease and affects 1% of the population above 60 years old. Although Parkinson’s disease commonly manifests with motor symptoms, a majority of patients with Parkinson’s disease subsequently develop cognitive impairment, which often progresses to dementia, a major cause of morbidity and disability. Parkinson’s disease is characterized by α-synuclein accumulation that frequently associates with amyloid-β and tau fibrils, the hallmarks of Alzheimer’s disease neuropathological changes; this co-occurrence suggests that onset of cognitive decline in Parkinson’s disease may be associated with appearance of pathological amyloid-β and/or tau. Recent studies have highlighted the appearance of the soluble form of the triggering receptor expressed on myeloid cells 2 (sTREM2) receptor in CSF during development of Alzheimer’s disease. Given the known association of microglial activation with advancing Parkinson’s disease, we investigated whether CSF and/or plasma sTREM2 differed between CSF biomarker-defined Parkinson’s disease participant subgroups. In this cross-sectional study, we examined 165 participants consisting of 17 cognitively normal elderly subjects, 45 patients with Parkinson’s disease with no cognitive impairment, 86 with mild cognitive impairment, and 17 with dementia. Stratification of subjects by CSF amyloid-β and tau levels revealed that CSF sTREM2 concentrations were elevated in Parkinson’s disease subgroups with a positive tau CSF biomarker signature, but not in Parkinson’s disease subgroups with a positive CSF amyloid-β biomarker signature. These findings indicate that CSF sTREM2 could serve as a surrogate immune biomarker of neuronal injury in Parkinson’s disease.

MO531IMPACT OF INFLAMMATORY MARKERS IN COGNITIVE IMPAIRMENT IN CHRONIC KIDNEY DISEASE PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Merita Rroji (Molla) ◽  
Larisa Shehaj ◽  
Myftar Barbullushi
Keyword(s):  
Chronic Kidney Disease ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Kidney Disease ◽  
Inflammatory Markers ◽  
Routine Practice ◽  
Increased Risk ◽  
Ckd Stage ◽  
The Mean ◽  
Hs Crp

Abstract Background and Aims Cognitive impairment is an increasingly identified major cause of chronic disability and is commonly found in patients with chronic kidney disease (CKD). Knowledge of the link between kidney dysfunction and impaired cognition may enhance our understanding of risk factors impacting cognitive dysfunction. Our study aimed to evaluate the relation between serum inflammatory markers and the risk of cognitive decline among adults with CKD. Method Forty-six patients predialysis patients CKD stage 5 (mean age 55.6±11.5 years old) accepted to participate in the study. The Montreal Cognitive Assessment (MoCA) scale was administered to patients. Patients with a MoCA global score of 24/30 were considered cognitively impaired. Descriptive analysis was done for the socio-demographic and clinical variables. We measured high-sensitivity C-reactive protein (hs-CRP), ferritin level, albuminemia, and fibrinogen in baseline plasma samples. Results The mean total MoCA score for all the patients was 22.9 ±3.8 points. Thirty-seven patients, 57.7%, were evaluated with CI, where 74.6 % with Mild CI (MCI) and 25.4% with severe CI (SCI) under 20 points). MoCA subscale analysis revealed that the mean score for visuospatial/executive domain and attention were the lowest with 5.41±1.1 /8max and 2.93±1.75/6 max, and scores for orientation were the highest 5.92±0.57/6 max. At baseline, higher levels of each inflammatory marker were associated with poorer age-adjusted performance. In analyses adjusted for baseline cognition, demographics, comorbid conditions, and kidney function, participants in the highest tertile of hs-CRP, the highest tertile of fibrinogen, and the highest tertile of ferritin had an increased risk of impairment in attention compared to participants in the lowest tertile of each marker (p=0.043, p=0.047, p=0.029, respectively. The high level of ferritin was evaluated as a risk of impairment visuospatial/executive ability, and no relationship of inflammatory markers was observed with impairment of orientation p=0.01. hs-CRP and ferritin and low albumin level were independently associated with longitudinal global cognitive function (p=0.04, p=0.02, p=0.49 respectively). Conclusion In CKD patients, we have a relatively high risk for cognitive impairment. Our results extend the findings from prior studies by showing that inflammatory markers used in routine practice contribute and are independently associated with longitudinal changes in some domains of cognitive function in patients with CKD going in parallel with the inflammatory mechanisms that have been implicated in the pathogenesis of vascular and Alzheimer’s dementia.

scholarly journals Twinning rate in a sample from a Brazilian hospital with a high standard of reproductive care

2001 ◽  
Vol 119 (6) ◽  
pp. 216-219 ◽  
Author(s):  
Gloria Maria Duccini Dal Colletto ◽  
Conceição Aparecida de Mattos Segre ◽  
Bernardo Beiguelman
Keyword(s):  
High Frequency ◽  
Maternal Age ◽  
Private Hospital ◽  
High Standard ◽  
Southeastern Brazil ◽  
Increased Risk ◽  
The Mean ◽  
Very High ◽  
Assisted Fertilization

CONTEXT: Epidemiological studies on twin births have been motivated mostly by the positive correlation between twinning rate and human fertility, prematurity, low birth weight, increased risk of infant death and long term risk for morbidity. OBJECTIVE: This paper intends to estimate the incidence of multiple births in a private hospital in Brazil with a high standard of reproductive care, and to evaluate the effects of maternal age, gestation order and assisted fertilization on twinning rate. DESIGN: Retrospective analysis. SETTING: First-class tertiary private hospital, São Paulo, Brazil. PARTICIPANTS: The multiple birth rate was investigated among 7,997 deliveries from 1995 to 1998, including 7,786 singletons, 193 twins, 17 triplets and one quadruplet. RESULTS: The rates per 1,000 dizygotic and monozygotic pairs and for triplets were estimated as 19.51, 4.50 and 2.13, respectively. The dizygotic and triplet rates were the highest observed in Brazil up to the present day. The twinning rate among primigravidae older than 30 years was very high (45.02 per 1,000) and was due to a disproportionately high frequency of dizygotic pairs. The triplet rate was also very high among the mothers of this age group (5.71 per 1,000). These facts are strong indicators that these women were the ones most frequently submitted to assisted reproductive techniques. The mean maternal age of the studied population was about six years higher than that estimated for mothers in the general population of southeastern Brazil. Primigravidae aged under 30 years as well as multigravidae showed similar twinning rates, which were almost 20 per 1,000. Among the deliveries of multigravidae older than 30 years, an unusually high frequency of monozygotic twins was observed (7.04 per 1,000), probably as a consequence of the residual effect of long-term use of oral contraceptives. CONCLUSIONS: The dizygotic twinning rate increased from 13.51 to 28.98 per 1,000 over the four years studied, with the twinning rate for primigravidae over 30 years old in 1998 being twice that observed in 1995. The mean maternal age was also high during this period, but the extremely high increase in twinning rate observed cannot be attributed solely to this variable. Assisted fertilization seems to be the most probable cause of this unusually high twinning rate.

A cluster-controlled clinical trial of two prophylactic silicone sacral dressings to prevent sacral pressure injuries in critically ill patients

2019 ◽  
pp. 21-26 ◽  
Author(s):  
Monica Stankiewicz ◽  
Jodie Gordon ◽  
Joel Dulhunty ◽  
Wendy Brown ◽  
Hamish Pollock ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Intensive Care ◽  
Similar Efficacy ◽  
Care Patient ◽  
Controlled Clinical Trial ◽  
Cost Difference ◽  
Increased Risk ◽  
Pressure Injury ◽  
Risk Patients ◽  
The Mean

Objective Patients in the intensive care unit (ICU) have increased risk of pressure injury (PI) development due to critical illness. This study compared two silicone dressings used in the Australian ICU setting for sacral PI prevention. Design A cluster-controlled clinical trial of two sacral dressings with four alternating periods of three months' duration. Setting A 10-bed general adult ICU in outer-metropolitan Brisbane, Queensland, Australia. Participants Adult participants who did not have a sacral PI present on ICU admission and were able to have a dressing applied for more than 24 hours without repeated dislodgement or soiling in a 24-hour period (>3 times). Interventions Dressing 1 (Allevyn Gentle Border Sacrum™, Smith & Nephew) and Dressing 2 (Mepilex Border Sacrum™, Mölnlycke). Main outcomes measures The primary outcome was the incidence of a new sacral PI (stage 1 or greater) per 100 dressing days in the ICU. Secondary outcomes were the mean number of dressings per patient, the cost difference of dressings to prevent a sacral PI and product integrity. Results There was no difference in the incidence of a new sacral PI (0.44 per 100 dressing days for both products, p = 1.00), the mean number of dressings per patient per day (0.50 for both products, p = 0.51) and product integrity (85% for Dressing 1 and 84% for Dressing 2, p = 0.69). There was a dressing cost difference per patient (A$10.29 for Dressing 1 and A$28.84 for Dressing 2, p < 0.001). Conclusions Similar efficacy, product use and product integrity, but differential cost, were observed for two prophylactic silicone dressings in the prevention of PIs in the intensive care patient. We recommend the use of sacral prophylactic dressings for at-risk patients, with the choice of product based on ease of application, clinician preference and overall cost-effectiveness of the dressing.

Prevalence of metabolic syndrome in never treated mood disordered patientss

2007 ◽  
Vol 30 (4) ◽  
pp. 95
Author(s):  
Valerie Taylor ◽  
Glenda M. MacQueen
Keyword(s):  
Metabolic Syndrome ◽  
Mood Disorders ◽  
Population Attributable Risk ◽  
Disease Process ◽  
Visceral Obesity ◽  
Premature Mortality ◽  
Overweight And Obesity ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Bipolar Patients

Bipolar disorder and major depression are life-shortening illnesses. Unnatural causes such as suicide and accidents account for only a portion of this premature mortality1 Research is beginning to identify that mood disordered patients have a higher incidence of metabolic syndrome, an illness characterized by dyslipidemia, impaired glucose tolerance, hypertension and obesity.2 Metabolic syndrome is associated with an increased risk for a variety of physical illnesses. Hypothesis: Never treated patients with mood disorders have preexisting elevations in the prevalence of the component variables of metabolic syndrome. Central obesity will be especially elevated, predicting increased premature mortality. Methods: We assessed never treated patients with mood disorders for metabolic syndrome and its component variables. Patients were assessed at baseline and followed up at 6-month intervals. All psychiatric pharmacotherapy was documented. Body mass index (BMI) was also obtained and the percentage of deaths attributable to overweight and obesity was calculated using the population attributable risk (PAR). [PAR= ∑[P (RR-1)/RR] Results: Prior to the initiation of treatment, patients did not differ from population norms with respect to metabolic syndrome or BMI. At 2-year follow-up, BMI had increased for unipolar patients 2.02 points and 1.92 points for bipolar patients. (p < .001) This increase in BMI predicted an increase in mortality of 19.4%. Conclusion: An increase in visceral obesity is often the first component of metabolic syndrome to appear and may indicate the initiation of this disease process prematurely in this group. The increase in BMI places patients with mood disorders at risk for premature mortality and indicates a need for early intervention. References 1.Osby U, Brandt L, Correia N, Ekbom A & Sparen P. Excess mortability in bipolar and Unipolar disorder rin Sweden. Archives of General Psychiatry, 2001;58: 844-850 2.Toalson P, Saeeduddin A, Hardy T & Kabinoff G. The metabolic syndrome in patients with severe mental illness. Journal of Clinical Psychiatry, 2004; 6(4): 152-158

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