Environmental characteristics, nutritional and executive functions in children of 6 to 7 years

This study aimed to analyze the socio-environmental characteristics, executive and nutritional functions in children aged 6 to 7 years, from public schools in Alagoas, Brazil. A quantitative, cross-sectional and descriptive study was performed involving 64 children of the mentioned age group, from public schools located in Alagoas: Maceió, on the coast; Major Isidoro, in the hinterland and Palmeira dos Índios, in the country. Such analyzes were made through the application of neuropsychological tests and anthropometric assessment with children and food and socio-environmental surveys with their parents. As for the type of housing, 100% were made of masonry, with a bathroom present in 98.4%. All children reported with the habit of bathing in the river / lagoon, presented some pathology. There was no significant difference between cities in terms of the sociodemographic characteristics evaluated, with the same result occurring with the factors associated with the occurrence of diseases in children. The subtests of WISC-IV, were below the average in all municipalities, and the TAC and SCC were classified within the average. However, even though the ranking were divided between below average and average, it is possible to identify from the subtests of WISC-IV, that the general IQ showed a cognitive level below the average. There was also no significant difference in the anthropometric assessment (weight, height, BMI and IMCI) between the evaluated students. The average weight was 23.3 kg to 25 kg, the height between 1.23 m to 1.24 m, the BMI between 16.4 to 17; the IMCI from 2.8 to 3.0. Children were classified within the average. Regarding micronutrients (Ca, Fe, K, Mg and Na, and vitamins A, C, D, B1, B9 and B12) and calories, there was also no significant difference between the cities evaluated. The same occurred with macronutrients (proteins, carbohydrates and lipids). This study showed that in general there was no difference between the students of the three municipalities. Probably, even though they are all public schools and from different cities, children have similar social conditions.

Particularities of Electrophysiological and Psychoneurological Assessment of Mild Traumatic Brain Injury

Neuropsychological functioning after mTBI is individualized and dynamic, with no currently known predictors and usually having a trajectory of gradual improvement. It is still a challenge to identify specific cognitive profiles associated with mTBI. One of the causes is the transient character of TBI symptoms as they are not appearing immediately after the injury. Another explanation resides in the individual and group variability of cognitive impairements following mTBI, which also affects the standardisation of the neuropsychological tests to use in mTBI assessment batteries (Iverson et al., 2013; Prince & Bruhns, 2017; Tulsky et al., 2017). Presently concussion has no accepted definition or diagnostic criteria. Also, there is no standard (or gold standard) for screening or properly identifying and diagnosing all population with concussion. (Borg et al., 2004). Patients with mTBI could evolve in a bunch of physical, cognitive, and emotional symptoms (Permenter et al., 2021) that are usually known as post-concussion syndrome (PCS). In terms of symptoms, we target neuropsychological evaluation of four key domains (“higher-order attention”, “executive function”, “episodic memory”, and “speed of information processing”) implicated in chronic impairment after mTBI. Alternatively, studies on the EEG frequency domain shed new light on the possibility to have a diagnostic marker based on QEEG patterns identified in the mTBI population and some prognostic factors for the PCS syndrome.(Rapp et al., 2015; Thornton & Carmody, 2009). Given the particularities of neuropsychological functioning after mTBI we emphasize the need of a mixed methodology, using both electrophysiological and psychoneurological tools, to provide the best sensitivity and specificity in assessing cognitive and functional deficits and in predicting further PCS.

Predictors of preoperative cognitive dysfunction in adults with Moyamoya disease: a preliminary research

Objective To explore potential risk factors of preoperative cognitive dysfunction in adult patients with moyamoya disease (MMD) and discuss significance of moyamoya vessels. Methods The author reviewed adult MMD patients harboring no parenchymal infarction or hemorrhage underwent a standardized neuropsychological assessment test battery from December 2018 to May 2019. The authors defined patients with cognitive dysfunction as cognitive impairment shown on 3 or more neuropsychological tests. According to the presence of cerebral angiography, arterial stenosis, moyamoya vessels, and compensatory arteries were conducted. Univariate and multivariate analyses were performed to identify predictors for cognitive dysfunction before surgery. Subgroup analyses by onset type and Suzuki stage were carried out to identify specific predictors for preoperative cognitive dysfunction. Results In total, 29 of 92 (31.52%) patients had cognitive dysfunction. Multivariate analysis showed that moyamoya vessels generating from left hemisphere was recognized as independent predictor for cognitive dysfunction (P = 0.025, OR [95%CI], 0.085 [0.012–0.874]). For patients in left ICA-moyamoya subgroup, 19 of 45 (42.22%) cases with sparse moyamoya vessels had cognitive dysfunction (P = 0.031), while 22 (91.67%) of patients with dense moyamoya vessels had normal cognition (P = 0.004). Moyamoya vessels arising from ophthalmic artery had no significant association with cognitive dysfunction (P = 0.111). Multivariate analysis found that moyamoya vessels originating from left ICA was recognized as independent predictors for preoperative cognitive dysfunction (P = 0.048, OR [95%CI], 0.394 [0.132–0.926]). Conclusions Moyamoya vessels arising from left hemisphere was a risk factor for the preoperative cognitive dysfunction in adult patients with MMD, with the denser moyamoya vessels, the less cognitive dysfunction. The current study offers a new perspective of moyamoya vessels and supporting data for choosing MMD candidates on cerebral revascularization.

Cognitive Rehabilitation in Multiple Sclerosis in the Period from 2013 and 2021: A Narrative Review

Background: In recent years, several blinded randomized controlled trials (RCT) have been conducted on cognitive rehabilitation (CR) in adults with multiple sclerosis (MS). Objective: To review all blinded RCTs on CR in MS published since 2013. Methods: The National Library of Medicine database (Medline) and PSYCINFO were searched using the keywords MS and CR or cognitive training or NP rehabilitation or memory rehabilitation or attention rehabilitation. Results: After the exclusion of some papers not specifically focused on CR, a final list of 26 studies was established. The papers belong to three main categories: individual specific rehabilitation (8studies), group rehabilitation (4 studies), and computerized training (CT) (14 studies), while one study combined group rehabilitation and CT. Among the individual rehabilitation studies, 5 were devoted to memory, and most of the 19 other selected studies were about several cognitive domains. Most of the studies mainly concerned RRMS patients, except for 2 studies that were carried out exclusively in progressive forms. Despite the methodological limitations of some studies and the great heterogeneity of the protocols, the results are generally in favor of the efficacy of CR in neuropsychological tests. Conclusion: Recent blinded RCTs about CR in MS show promising results.

Cerebrovascular Reserve Capacity as a Predictor of Postoperative Delirium: A Pilot Study

Introduction: Postoperative delirium is a common complication after cardiac surgery with cardiopulmonary bypass (CPB). Compromised regulation of the cerebral circulation may be a predisposing factor for delirium. However, the potential relationship between cerebrovascular reserve capacity and delirium is unknown. The aim of this study was to investigate if impaired cerebrovascular reserve capacity was associated with postoperative delirium.Methods: Forty-two patients scheduled for cardiac surgery with CPB were recruited consecutively. All patients underwent preoperative transcranial Doppler (TCD) ultrasound with calculation of breath-hold index (BHI). BHI < 0.69 indicated impaired cerebrovascular reserve capacity. In addition, patients were examined with preoperative neuropsychological tests such as MMSE (Mini Mental State Examination) and AQT (A Quick Test of cognitive speed). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) in which a score of ≥2 was considered as delirium.Results: Six patients (14%) scored high for postoperative delirium and all demonstrated impaired preoperative cerebrovascular reserve capacity. Median (25th−75th percentile) BHI in patients with postoperative delirium was significantly lower compared to the non-delirium group [0.26 (−0.08–0.44) vs. 0.83 (0.57–1.08), p = 0.002]. Preoperative MMSE score was lower in patients who developed postoperative delirium (median, 25th−75th percentile; 26.5, 24–28 vs. 28.5, 27–29, p = 0.024). Similarly, patients with postoperative delirium also displayed a slower performance during the preoperative cognitive speed test AQT color and form (mean ± SD; 85.8 s ± 19.3 vs. 69.6 s ± 15.8, p = 0.043).Conclusion: The present findings suggest that an extended preoperative ultrasound protocol with TCD evaluation of cerebrovascular reserve capacity and neuropsychological tests may be valuable in identifying patients with increased risk of developing delirium after cardiac surgery.

Deep Learning With 18F-Fluorodeoxyglucose-PET Gives Valid Diagnoses for the Uncertain Cases in Memory Impairment of Alzheimer’s Disease

Objectives: Neuropsychological tests are an important basis for the memory impairment diagnosis in Alzheimer’s disease (AD). However, multiple memory tests might be conflicting within-subjects and lead to uncertain diagnoses in some cases. This study proposed a framework to diagnose the uncertain cases of memory impairment.Methods: We collected 2,386 samples including AD, mild cognitive impairment (MCI), and cognitive normal (CN) using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and three different neuropsychological tests (Mini-Mental State Examination, Alzheimer’s Disease Assessment Scale-Cognitive Subscale, and Clinical Dementia Rating) from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). A deep learning (DL) framework using FDG-PET was proposed to diagnose uncertain memory impairment cases that were conflicting between tests. Subsequent ANOVA, chi-squared, and t-test were used to explain the potential causes of uncertain cases.Results: For certain cases in the testing set, the proposed DL framework outperformed other methods with 95.65% accuracy. For the uncertain cases, its positive diagnoses had a significant (p < 0.001) worse decline in memory function than negative diagnoses in a longitudinal study of 40 months on average. In the memory-impaired group, uncertain cases were mainly explained by an AD metabolism pattern but mild in extent (p < 0.05). In the healthy group, uncertain cases were mainly explained by a non-energetic mental state (p < 0.001) measured using a global deterioration scale (GDS), with a significant depression-related metabolism pattern detected (p < 0.05).Conclusion: A DL framework for diagnosing uncertain cases of memory impairment is proposed. Proved by longitudinal tracing of its diagnoses, it showed clinical validity and had application potential. Its valid diagnoses also provided evidence and explanation of uncertain cases based on the neurodegeneration and depression mental state.

The Correlation between a New Online Cognitive Test (the Brain Assessment) and Widely Used In-Person Neuropsychological Tests

<b><i>Introduction:</i></b> There are several problems with standard in-person neuropsychological assessments, such as habituation, necessity of human resources, and difficulty of in-person assessment under societal conditions during the outbreak of coronavirus disease 2019. Thus, we developed an online cognitive test (the Brain Assessment [BA]). In this study, we investigated the correlation between the results of the BA and those of established neuropsychological tests. <b><i>Participants and Methods:</i></b> Seventy-seven elderly persons (mean 71.3 ± 5.1 years old; range 65–86; male:female = 45:32) were recruited through the internet. Correlations were evaluated between the BA and the following widely used neuropsychological tests: the mini-mental state examination (MMSE), the Raven’s colored progressive matrices (RCPM), the logical memory I and II of the Rivermead Behavioral Memory Test, the word fluency (WF) test, and the Trail-Making TestA/B. <b><i>Results:</i></b> We found moderate correlations between the total cognitive score of the BA and the total score of the MMSE (<i>r</i> = 0.433, <i>p</i> &#x3c; 0.001), as well as between the total BA score and the total RCPM score (<i>r</i> = 0.582, <i>p</i> &#x3c; 0.001) and time to complete the RCPM (<i>r</i> = 0.455, <i>p</i> &#x3c; 0.001). Moderate correlations were also observed between the cognitive score of the memory of words BA subtest and the LM-I (<i>r</i> = 0.518, <i>p</i> &#x3c; 0.001), the mental rotation subtest and figure drawing (<i>r</i> = 0.404, <i>p</i> &#x3c; 0.001), the logical reasoning subtest and total RCPM score (<i>r</i> = 0.491, <i>p</i> &#x3c; 0.001), and the memory of numbers and words subtests and WF (memory of numbers and total WF: <i>r</i> = 0.456, <i>p</i> &#x3c; 0.001; memory of words and total WF: <i>r</i> = 0.571, <i>p</i> &#x3c; 0.001). <b><i>Discussion:</i></b> We found that the BA showed moderate correlations between established neuropsychological tests for intellect, memory, visuospatial function, and frontal function. The MMSE and the RCPM reflect Spearman’s s-factor and g-factor, respectively, and thus the BA also covered both factors. <b><i>Conclusion:</i></b> The BA is a useful tool for assessing the cognitive function of generally healthy elderly persons.

Depression Affects Working Memory Performance: A Functional Near Infrared Spectroscopy (fNIRS) Study*

Depression is a complex disorder that can be caused by psychosocial and biological conditions and it not only effects mood disorders, but also cognitive functions such as memory, decision making, psychomotor speed and attention. As a result of the studies, some findings indicate that depressed individuals perform worse in neuropsychological tests than healthy individuals, while other studies indicate there is no difference between the two groups. According to neuroimaging studies on this subject, functional and anatomical differences were detected at the cortex and subcortical levels in the prefrontal lobe. This study is consisting of two parts, behavioral and neuroimaging using fNIRS. BDI was applied to the participants. The average age of the group with lower BDI score is 23,9±3,04; the average age of the higher group with higher BDI score is 22,2+2,28. A visuospatial 2-back task, which includes 4 different stimulus types with neutral, emotional, verbal, and non-verbal qualities, was applied to the participants. No significant differences were observed between the two groups in behavioral data. However, when fNIRS results were examined, it was found that the group with the high BDI scores showed more activation in the right PFC during the visuospatial 2-back task compared to the group with low BDI scores. Although the fNIRS results are consistent in the literature, behavioral findings support some of the findings in literature, while contradicting others. It is thought that the reason for this may be that participants are young, and the 2-back task is not difficult enough.

Prediction of Postoperative Delirium after Gastrointestinal Surgery Using the Mie Constructional Apraxia Scale

<b><i>Background:</i></b> Postoperative delirium (POD) is a transient postoperative complication that occurs after surgical procedures. Risk factors reported for POD include dementia and cognitive decline. The purpose of this study was to identify predictors of POD by examining the use of preoperative neuropsychological tests, including the Mie Constructional Apraxia Scale (MCAS), and patient background factors. <b><i>Method:</i></b> The study was performed as a retrospective cohort study. The subjects were 33 patients (mean age, 75.8 ± 10.9 years; male:female ratio, 26:7) who underwent gastrointestinal surgery at Matsusaka City Hospital between December 2019 and April 2021. Data were collected retrospectively from medical records. The study was started after receiving approval from the institution’s ethics committee. The survey items included general patient information, nutritional assessment, surgical information, and neuropsychological tests. Subjects were classified into 2 groups according to the presence or absence of POD. If a significant difference was observed between the 2 groups, the sensitivity, specificity, and area under the curve were calculated using a receiver operating characteristic (ROC) curve. <b><i>Result:</i></b> There were 10 patients in the POD group (male:female ratio, 6:4) and 23 patients in the non-POD group (20:3). The POD group had a shorter education history (<i>p</i> = 0.047) and significantly higher MCAS scores (<i>p</i> = 0.007) than the non-POD group. The ROC curve showed a sensitivity of 90%, a specificity of 69%, and an area under the curve of 0.798 when the MCAS cutoff value was set at 3 points. <b><i>Conclusion:</i></b> Preoperative MCAS results were capable of predicting the occurrence of POD after gastrointestinal surgery. In addition, a relatively short education background was also considered a risk factor for POD.