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"THE RELATION OF HYPERHOMOCYSTEINEMIA TO COGNITIVE FUNCTION AND BRAIN ATROPHY IN PATIENTS WITH MULTIPLE SCLEROSIS "
M. Ghaffarpour,M. Maghbooli,M. H. Harirchian H. M. Ghabaie-Hashemi
Acta Medica Iranica , 2007,
Abstract: Cognitive impairment may be a common even at the onset of multiple sclerosis (MS). In this case-control study, we tried to find out the probable relationship between homocysteine levels and cerebral atrophy or cognitive impairment in patients with multiple sclerosis. One hundred fifty six patients who had MS according to McDonald diagnostic criteria were included in this study. Patients’ age, gender, and educational level, MS duration and clinical type, disability, cognitive function state based on minimental state examination (MMSE), presence of hyperhomocysteinemia, and brain atrophy were evaluated. There was no statistically significant relationship between hyperhomocysteinemia and cognitive status. Total homocysteine levels had a significant correlation with MMSE score only in those patients with elementary level of education. Also total homocysteine levels and overall cerebral atrophy did not indicate significant relationship according to those independent variables mentioned above except in the patients with EDSS less than 6. When intercaudate ratio > 0.10 was applied as a criterion for cerebral atrophy, we found that hyperhomocysteinemia related significantly to intercaudate ratio > 0.10 in females, aged between 21 and 30 years, MS duration ≤ 5 years, primary progressive MS and relapsing-remitting MS clinical types, EDSS ≤ 3 and elementary level of education. We suggest applying MMSE only for the first step of cognitive function survey. In the next steps, much more exact test must be used (e.g. MSNQ). Also we can not suggest measuring plasma homocysteine level as criterion for monitoring the cognitive function in patients with MS.
Cognitive Impairment In Relapsing Remitting Multiple Sclerosis Patients  [PDF]
Tuncer N,Midi I,Feyzioglu A
Journal of Neurological Sciences , 2012,
Abstract: The purpose of this study is to evaluate the cognitive functions in cases with relapsing remitting MS during the period in which the physical disability is seen in a lower level, as well as to examine the level and predominant domain of cognitive loss while relating it with the duration of the disease, degree of disability, and number of the episodes.Materials and Methods: Twenty five (25) patients with relapsing remitting MS were included in the study.Neuropsychological test battery which is used for the assessment of cognitive functions included tests for verbal and visual memory, simple attention and sustained attention, executive functions, visuospatial ability and language. The results were compared with 17 healthy controls matched for age, gender and education level.Results: When the patient and control groups were compared, a significant impairment was observed in MS patients on short and long time free recall and clue recall, recognition processes, recent memory and free recall processes, attention and ability to maintain attention, verbal fluency and categoric fluency during memory tests, while impairment was detected in frontal functions such as difficulty in response inhibition, perseverations in Luria drawings.Conclusion: Cognitive impairment affects the quality of life independent from disability scores, and highly informative during follow-ups as it indicates the progression of the disease. Therefore, cognitive assessment should be included in routine follow-ups. Further studies are warranted to improve the definition of the limits of cognitive impairment, to highlight the physiopathogenic mechanisms and to develop treatment principles in MS
Cognitive impairment in a Brazilian sample of patients with bipolar disorder
Schneider, Júlia J;Candiago, Rafael H;Rosa, Adriane R;Ceresér, Keila M;Kapczinski, Flávio;
Revista Brasileira de Psiquiatria , 2008, DOI: 10.1590/S1516-44462008000300006
Abstract: objective: persistent neurocognitive deficits have been described in bipolar mood disorder. as far as we are aware, no study have examined whether the cognitive impairment is presented in the same way in a brazilian sample. method: cognitive function of 66 patients with bipolar disorder (32 with depressive symptoms and 34 euthymic) and 28 healthy subjects was examined using a complete cognitive battery. results: patients with bipolar disorder presented a significantly poorer performance in eight of the 12 subtests when compared to healthy subjects. there was no significant difference between the subgroups of patients. these patients showed impairment in both verbal and non-verbal cognitive function. conclusion: cognitive impairment was found in both groups of patients with bipolar disorder. the findings described here suggest an overall impairment of cognitive function, independent of mood symptoms. this is in line with data showing that cognitive deficits may be a persistent characteristic of bipolar disorder.
The Effectiveness of Cognitive Rehabilitation on Improving the Selective Attention in Patients with Mild Cognitive Impairment  [PDF]
Arezoo Shomali Oskoei, Vahid Nejati, Bita Ajilchi
Journal of Behavioral and Brain Science (JBBS) , 2013, DOI: 10.4236/jbbs.2013.36049
Abstract: Purpose: The aim of the present study is to evaluate the effectiveness of cognitive rehabilitation on improving selective attention in patients with mild cognitive impairment. Methods: It was a quasi-experimental study with pre-test and post-test. The population in this study was all individuals referred to a neurology clinic in Tehran in 2012. The group was comprised of 40 patients with mild cognitive impairment who were evaluated with early detection and assessment by a medical psychologist (MMSE score lower than 25 and Wechsler memory test) and were selected by available sampling. They were also older than 55 years and had a minimum education at degree level, together with a lack of neurological and psychiatric comorbidities and impaired sensory and motor retardation, according to their nursing history and medical records. They were randomly divided into experimental and control groups (20 patients in each group). The experimental group was given 12 sessions (two hours each section) of cognitive rehabilitation with Neurocognitive Joyful Attentive Training Intervention (NEJATI). The control group, as expected with this group, did not receive any trial period. The selective attention of both groups was evaluated, before and after receiving intervention, by a Strop computer programme. Data were analysed using the covariance statistical test, MANCOVA. Results: The results show an increase in selective attention scores in the experimental group compared with the control group. Therefore, we can conclude that cognitive rehabilitation leads to improvement in the performance of selective attention (F = 4/97; sig < 0/05). Conclusion: Cognitive rehabilitation can impact on improving selective focus in people with mild cognitive impairment.
Dementia and mild cognitive impairment in patients with Parkinson's disease
Tedrus, Gloria Maria Almeida Souza;Fonseca, Lineu Corrêa;Letro, Grace Helena;Bossoni, Alexandre Souza;Samara, Adriana Bastos;
Arquivos de Neuro-Psiquiatria , 2009, DOI: 10.1590/S0004-282X2009000300010
Abstract: the objective of this research was to assess the occurrence of cognitive impairment in 32 individuals (average age: 67.2 years old) with parkinson' disease (pd). procedures: clinical-neurological assessment; modified hoehn and yahr staging scale (hys); standard neuropsychological battery of cerad (consortium to establish a registry for alzheimer' disease); pfeffer questionnaire; and clinical dementia rating. a comparison was made with a control group (cg), consisting of 26 individuals with similar age and educational level but without cognitive impairment. the pd patients showed an inferior performance in the cerad battery when compared to the cg. three pd sub-groups were characterised according to cognition: no cognitive impairment - 15 cases; mild cognitive impairment - 10; dementia - 7 cases. there was a significant association between motor disability (hys) and the occurrence of dementia. dementia and mild cognitive impairment frequently occur in pd patients and should be investigated in a routine way.
Cognitive Impairment in Patients with Early Relapsing-Remitting Multiple Sclerosis
Hava D?nmez KEKL?KO?LU
N?ropsikiyatri Ar?ivi , 2010,
Abstract: Objective: Cognitive impairment is a common symptom in every phase and every type of multiple sclerosis. Different results, between 32% and 70%, have been reported in studies on the incidence and characteristics of cognitive impairment in patients with relapsing-remitting multiple sclerosis (RRMS). This big difference is explained by the use of different neuropsychological tests and different patient groups. The aim of this study was to analyze the incidence and characteristics of cognitive impairment in patients with early RRMS by applying standardized Turkish neuropsychological tests, commonly used in our country.Methods: 67 patients followed with diagnosis of RRMS and with disease duration up to 5 years were enrolled in the study. All participants underwent neuropsychological, magnetic resonance imaging (MRI) and clinical evaluation. Functional deficits of the subjects were assessed using the Expanded Disability Status Scale (EDSS). The patients without depression according to the Hamilton Depression Rating Scale (HDRS), underwent the Frenchay Aphasia Screening Test (FAST), the Standardized Mini-Mental State Examination (SMME) and the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog). All results were assessed statistically.Results: Out of 67 RRMS patients (41 women, 26 men) evaluated in this study, 17 (23.4%) patients had depression. Of the rest 50 patients, 7 (14%) had a cognitive impairment according to SMME, 22 (44%) patients had cognitive impairment according to ADAS-cog and 1 patients had aphasia according to FAST. No statistically significant correlation was observed between cognitive impairment and clinical features, EDSS score or cranial MRI lesion load.Conclusion: Our results suggest that 44% of patients with early RRMS had cognitive impairment. There was no statistically significant correlation between cognitive impairment, EDSS score or number of lesions on cranial MRI. (Archives of Neuropsychiatry 2010; 47: 88-90)
Spectrum of Cognitive Impairment in Korean ALS Patients without Known Genetic Mutations  [PDF]
Seong-il Oh, Aram Park, Hee-Jin Kim, Ki-Wook Oh, Hojin Choi, Min-Jung Kwon, Chang-Seok Ki, Hee-Tae Kim, Seung Hyun Kim
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0087163
Abstract: Background Cognitive impairment is associated with a negative prognosis in amyotrophic lateral sclerosis (ALS), as well as with clinical specificity. We investigate neuropsychological function in ALS patients without known genetic mutations in a Korean tertiary clinic. Methods Three hundred and eighteen patients were enrolled in a prospective longitudinal cohort from September 2008 to February 2012. At the time of diagnosis of sporadic ALS, we carried out genetic and comprehensive neuropsychological tests on all patients, and collected demographic and clinical characteristics. Six cognitive domains, namely executive function, attention, language, calculation, visuospatial function and memory were evaluated. ANOVA and t-tests were used to assess differences in clinical characteristics and neuropsychological parameters between sporadic ALS patients. The Kaplan-Meier method and Cox proportional hazard model were used for survival analysis. Results One hundred and sixty-six patients were categorized into five subtypes: normal cognition (ALS pure), cognitive impairment (ALSci), behavioral impairment (ALSbi), frontotemporal dementia (ALS-FTD), and other types of dementia. Seventy patients (70/166, 42.2%) were cognitively or behaviorally impaired. Among the impaired patients, eight (8/166, 4.8%) had FTD-type dementia and one (1/166, 0.6%) was Alzheimer's disease-type. The ALS patients with cognitive impairment (ALSci) and with FTD (ALS-FTD) were more severely impaired in executive function, attention, language and memory than the cognitively intact ALS patients (ALS pure). In a survival analysis, ALSci (β = 1.925, p = 0.025) and ALS-FTD groups (β = 4.150, p = 0.019) tended to have shorter survival than the ALS pure group. Conclusions About half of ALS patients without known genetic variation have cognitive or behavioral impairment. ALS patients with cognitive abnormalities, especially FTD, have a poorer prognosis than those without cognitive impairment. In neuropsychological profiling, executive tasks were effective in identifying cognitive impairment in the ALS patients. It would be useful for clinicians to classify ALS according to neuropsychological profiles, and screen for subtle cognitive impairment.
Cognitive Impairment in Relapsing Remitting and Secondary Progressive Multiple Sclerosis Patients: Efficacy of a Computerized Cognitive Screening Battery  [PDF]
Athanasios Papathanasiou,Lambros Messinis,Vasileios L. Georgiou,Panagiotis Papathanasopoulos
ISRN Neurology , 2014, DOI: 10.1155/2014/151379
Abstract: Objective. To investigate the pattern of cognitive impairment in relapsing remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) patients using a computerized battery. Methods. RRMS patients , SPMS patients , and controls were assessed by Central Nervous System Vital Signs (CNS VS) computerized battery, Trail Making Tests (TMT) A and B, and semantic and phonological verbal fluency tasks. Results. The overall prevalence of cognitive dysfunction was 53.75% (RRMS 38%, SPMS 80%). RRMS patients differed from controls with large effect size on reaction time, medium effect size on TMT A and small on TMT B, phonological verbal fluency, composite memory, psychomotor speed, and cognitive flexibility. SPMS patients differed from controls in all neuropsychological measures (except complex attention) with large effect sizes on TMT A and B, phonological verbal fluency, composite memory, psychomotor speed, reaction time, and cognitive flexibility. Between patient groups, medium effect sizes were present on TMT B and psychomotor speed, while small effect sizes were present on composite memory and processing speed. Conclusion. CNS VS is sensitive in detecting cognitive impairment in RRMS and SPMS patients. Significant impairment in episodic memory, executive function, and processing speed were identified, with gradual increment of the frequency as disease progresses. 1. Introduction The functional consequences of cognitive impairment in multiple sclerosis (MS) patients can be devastating. Cognitive impairment has a direct impact on health-related quality of life at all stages of MS [1]. It reduces physical independence and social activities [2], competence in daily activities [3], personal and community independence [4], medication adherence [5], rehabilitation potential [6], and driving safety [7]. Cognitive impaired MS patients are more likely to be unemployed, while employed MS patients are cognitive preserved [8]. Large studies of MS patients have reported cognitive impairment prevalence rates between 40 and 70% [9, 10]. Cognitive impairment has been demonstrated at all stages and in all subtypes of the disease: clinically isolated syndrome (CIS), relapsing remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS), primary progressive multiple sclerosis (PPMS), and even benign multiple sclerosis [11]. However, the more severe levels of cognitive impairment tend to occur in the progressive phase [12]. Although almost all types of cognitive deficits can be observed in MS [13], the typical profile is
Mild Cognitive Impairment in Parkinson Disease: A Neuropsychological Study of 25 Patients  [PDF]
Siham Sanhaji, Mounia Rahmani, Maria Benabdeljlil, Mustapha El Alaoui Faris
World Journal of Neuroscience (WJNS) , 2018, DOI: 10.4236/wjns.2018.84037
Abstract: Parkinson’s disease (PD) is associated with an increased incidence of cognitive impairment and dementia. Population-based cohort of 25 patients with incident PD underwent a large neuropsychological battery. Executive functions were the most affected cognitive domain including particularly initiation, mental flexibility and inhibition. Episodic memory and visuo-spatial functions were less affected. We found that 92% of patients were classified as having Mild Cognitive Impairment (MCI); most of them experienced PD-MCI Single-Domain (17 patients) with disturbances on executive functions. Less frequently, we identified a group of patients with multiple-domain PD-MCI demonstrating deficits on executive functions as well as on episodic memory and/or visuospatial capacities.
Does Depression Impact Cognitive Impairment in Patients with Heart Failure?  [PDF]
Z. N. Sohani,Z. Samaan
Cardiology Research and Practice , 2012, DOI: 10.1155/2012/524325
Abstract: Prevalence studies have noted the cooccurrence of cognitive decline and depression in persons with heart failure. Cognitive impairment is associated with significant mortality and deteriorated quality of life, likely due to impairments in memory and executive function, which impact a patient’s ability to understand and comply with prescribed treatment plans. This is especially true in complex diseases such as heart failure. Evidence from literature supports the possibility of a pathophysiological relationship between cognitive impairment, depression, and heart failure. Yet, very few studies have sought to investigate this relationship. This paper reviews current literature on the association between depression and cognitive impairment in persons with heart failure and explores possible mechanisms explaining this complex triad. 1. Introduction Heart failure (HF) is a complex clinical syndrome characterized by a combination of symptoms and signs including shortness of breath, fatigue, edema as well as functional and structural cardiac abnormalities [1]. HF is estimated to affect about 3.9% (95% CI 3.0, 4.7) of the population aged 55 years or older [2] and 6.7% (95% CI 5.6, 7.9) of those aged 65–84 years [3]. Other studies have shown HF prevalence to increase with age, from as low as 0.9% of individuals aged less than 65 years up to 17.4% in those aged 85 years and older [4]. The burden of HF will likely continue to increase as the population ages. In fact, HF is a leading cause of hospital readmission and mortality [5]. Though less frequently examined, decline in cognitive functioning is common in patients with HF. A systematic review and meta-analysis including over 700 patients with congestive HF showed a significant reduction in attention and memory scores in patients compared to controls suggesting that cognitive impairment (CogI) may be associated with HF [6]. Further, a systematic review including 2937 patients and 14,848 controls showed a substantial (62%) increased risk of CogI in patients with HF [7]. Research into this cooccurrence has found CogI to impart an increased risk of mortality in those with HF (adjusted relative risk (RR) = 4.9; 95% CI 2.9, 8.3) [8]. To further the burden in HF patients, many researchers have found an increased prevalence of depression in this group. Data pooled from 36 studies showed prevalence rate of depression in HF to vary from 19.3% when depression is defined based on diagnostic interviews to 33.6% for depression based on questionnaires [9]. Despite the different methods of defining depression, at minimum one in
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